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THE 



KEY NOTES 



J 



1EDICAL PRACTI 



CH. G.VTCHELL, Al.D. 

11viekly professor of the theory and practice of 
University of Michigan, and Physician to Ukiv 
Hokpital : Attending Physician and Clinical, Le 
tukf.b to Cook County Hospital, Chicago ; 
Author of "How to Feed the Sick." 



A I . 



'l 1. LUSTRA f El 




chicTgo 

GROSS <fe DELBKIDGE 
1884 



G258k 
1994- 

TO 

RICHARD HUGHES, 
WHO 
HAS DONE 
SO MUCH TO LEND 
VALUE AND CHARACTER 
TO THE SCIENCE OF MEDICINE, - 
^TEFUL ACKNOWLEDGMENT OF MANY 
t ND IN MEMORY OF A PLEASANT DAY 
BRIGHTON BY THE SEA, 
THIS BOOK IS 
INSCRIBED 

BY HIS J 




CopuvUjhty Gross <fc- Deihridge, 1888. 



PREFACE. 



This book is intended to be a pocket companion for the busy prac- 
^t:oner. The effort has been to include in its pages that part of 
.l'> ; ne which makes up the bulk of the physician's daily practice. 

.a addition, I have endeavored to introduce much which forms 
t of a practical medical education, and yet is not taught in the 
ylege lecture-room; what older physicians have learned only after 
j rs of experience, and gradually accumulated. 

J directions for the management of the most pressing emergencies, 
• dicai, surgical and obstetric, are carefully given, while chronic 
ureases and rare cases, in the treatment of which there is always time 
and necessity for consulting larger works, receive no attention. 
A hand-book must treat of rules, not of exceptions. 

An effort has been made to give additional weight to many recom- 
mendations by attaching to them the names of those who are widely 
and favorably known in our profession. Thus I have made frequent 
reference to our most eminent systematic writer, Kichard Hughes, of 
England, who enriches and illuminates every subject which he touches. 
Baehr, Jous«et, Dunham, Guernsey, Jahr, Baye°, and numerous others, 
have been called upon for the results of their experience. 

I am much indebted to Dr. Chas. Adams, Attending Surgeon to Cook 
County Hospital, for very many contributions to the Part on Surgery, 
and the accuracy of the entire subject may be relied upon, since it has 
all undergone at his hands a careful and thorough revision. 

Dr. J. H. Buffum, author of " Diseases and Injuries of the Eye," 
has very kindly prepared for me the article on that subject, thus ren- 
dering it worthy of entire confidence. 

Dr. F. R. Day, formerly Resident Physician, Homoeopathic Depart- 
ment, Cook County Hospital, has favored me with the drawings from 
which the illustrations have been prepared, 
v i 



If those who have been many years in practice should seek in vain 1 
between these covers for remedies which they have at times found to 
be of signal service, let them reflect that if one thousand physicians, of 
our school, should each set about preparing a work of this character, 
there would be produced a thousand different books, with as great a 
variety of details as there were authors, and yet there would undoubt- 
edly be a general agreement upon the leading remedies for each and 
every disease. It is this common ground that I have attempted to 
occupy. CH. GATCHELL. 

Chicago, November, 7883. 



PART I. 

MEDICAL PRACTICE. 



FEVERS. 
FEVER AND CHILL TEMPERATURES. 

112.5° Faiir.— Highest ever recorded. 
107° or over — Death. 

106° to 107°— Almost always fatal; except in intermittent. 

105° to 106 = — Intense fever: recovery doubtful. 

104° to 105° — High fever; dangerous if long-continued. 

102° to 104° — Active fever; recovery the rule. 

101 c to 102° — Moderate fever. 

100° to 101°— Slight fever. 

. * to 100" — Feverishness. 
98.6° —Normal. 

97° to 98" — Subnormal; not grave. 

95° to 97°— Collapse: in itself without danger. 

93° to S5 = — Algid collapse: great danger, though recovery possible, 
92° to 93°— Fatal collapse. 

CONTINUED FEVERS. 

A Continued Fever is one which is marked by a con-, 
stantly elevated temperature, without sufficient remission 
or exacerbation to alter the course from that of a continu- 
ous action. 

TYPHOID FEVER. 

SYNONYMS: Enteric Fever; Abdominal Typhus. 

PROGNOSIS. Favorable: Pulse of 110 to 115, with 
distinct first sound; temperature not higher than 104 to 
105° Fahr. on eighth day; abdominal symptoms mild, and 
ceasing early. 

Unfavorable: The continuance of abdominal symptoms 
— so long as these last, patient not out of danger; pulse 
120 to 130. with feeble apex beat, and indistinct first sound ; 



6 



KEY NOTES OF MEDICAL PRACTICE. 



capillary bronchitis; haemorrhage from bowels; severe cys- 
titis; bed-sores; perforation of intestine (almost invariably, 
fatal). Prognosis also bad in fat persons, gouty subjects, 
and alcoholists; also if complicated by disease of kidneys, 
organic disease or degeneration of heart, oedema of lungs, 
pyaemia, or gastric catarrh. 

COMPLICATIONS. Pneumonitis; pleuritis; perfora- 
tion of bowel and peritonitis; intestinal haemorrhage; 
parotitis. 

CAUSES OF DEATH. Excessive haemorrhage; per- 
foration and peritonitis; pneumonitis; asthenia. 

LiEADIXCr REMEDIES. 

Baptisia. To be given as soon as typhoid fever is sus- 
pected, " in the period antecedent to the full development 
of the intestinal affection.'' — Hughes. Face dark red, witfc: 
a besotted expression; dull, stupefying headache, with con- 
fusion of ideas; tongue brown and dry, pulse full and soft, 
dull, aching pains. Also, throughout the course of the dis- 
ease, to reduce the high temperature. 

Bryonia. Violent, stupefying headache, restless sleep, 
with moaning and groaning, face red and swollen, delirium 
day and night, with strange fancies, desire to escape. 
Tongue coated with a yellowish fur, with parched lips, 
great thirst, vomiting, tenderness at pit of the stomach, 
and constipation. Of no use after the diarrhoea has set in. 

Belongs to treatment of mild cases, and li those in which the brain is 
not altogether deprived of its functional power." Baehr. 

Mereurius. Tongue loaded with thick, moist, creamy 
coating; painful sensibility of whole abdomen; diarrhoea, 
stools copious, liquid, flocculent, sometimes a little bloody. 
Clammy, foetid perspiration. 

"Indicated by predominance of abdominal symptoms." Joiisset. 
" Must be suspended as soon as tongue becomes dry and delirium mani- 
fests itself." Lilitnthal. 

Rhus tox. Mind dull and clouded, incoherent mutter- 
ing, or active delirium; headache, epistaxis, tongue brown 
and dry, with red tip; lips, teeth and tongue covered with 
sordes, skin clammy, general trembling, debility and pros- 
tration, pulse weak and slow, abdomen bloated, frequent, 
involuntary, copious, yellowish evacuations. This remedy 
belongs to the treatment of the intestinal stage of the dis- 
ease, after diarrhoea has set in. Also in pneumo-typhus, 
with epistaxis, severe bronchial affections, dirty-looking, 
sanguinolent expectoration. 

" Rhus corresponds to typhus of intense character, beginning with 
chill, followed by burning heat, and a copious diarrhcea, which sots in 
early." Baehr. 

Arsenicum. Extreme prostration, and great emacia- 



TYPHOID FEVER. 



7 



tion, face pale and shrunken, falling of lower jaw, tongue 
dry and cracked, black, with inability to protrude it. mouth 
covered with sordes, great thirst, decubitus, sopor, picking 
at bed-clothes, distended abdomen, pulse small, almost 
imperceptible, irregular action of the heart, with indis- 
tinctness of first sound, violent, almost continuous relaxa- 
tion of bowels, discharge very foetid. Breathing short and 
anxious, rattling cough, foetid breath. Symptoms of 
decomposition of the blood set in early, such as nose-bleed, 
bloody diarrhoea, bloody sputa, petechia? on the skin. 

This remedy should be given early, without waiting for 
the disease to develop its pernicious character. 

"A remedy of priceless value." Ruddock. "Sometimes restoring 
the patient when almost beyond hope/' Laurie. 

Mill*, ac. Extreme prostration, patient stupid and 
unconscious, sliding down in the bed, low, muttering 
delirium, picking at flocks, inability to protrude the tongue, 
depression of lower jaw, turning up of the eyes, involun- 
tary stools and urine. 



SPECIAli RE3IEI>IES. 

Opium. Coma, stertorous breathing. 
Hyos. Coma-vigil, or loquacious delirium. 
Toreb. Tympanites, and haemorrhage of bowels. 
" Well-nigh specific for tympanites." Hughes. 

Bell. Great cerebral congestion and furious delirium. 
Arnica. Low condition, with involuntary discharges. 
Ant. tart. Pneumo-typhus, with great rattling in chest, 
and dyspnoea. 

Plios. Pneumo-typhus, with violent bronchitis, hepati- 
zation, hypostasis and laryngitis. 
" Unsurpassed by any other medicine." Baehr. 



GENERAL MEASURES. 

Sick-room. Let it be a large, well-ventilated, upper 
room with open fire-place, if possible. Make free use of 
disinfectants, and look well to sewer-pipes, or other sources 
of impure air. Immediately remove all soiled clothing, 
and immerse in chlorine water, and boil within twenty-four 
hours; all other articles should be burned. Receive all dis- 
charges into porcelain bed-pan, and cover immediately with 
solution sulphate-of-iron. As soon as vessel is removed 
from patient, cover with an old cloth, to prevent exhala- 
tions from escaping into room, and immediately 

Dispose of Discharges, in the country, by emptying 
bed pan into a freshly-dug hole far-removed from a privy 
or well, and cover with dry earth. If in the city, empty 



KEY NOTES OF MEDICAL PRACTICE. 



into a water-closet, which must be used for no other purpoam 
At frequent intervals flush this closet with large quantities 
of solution of sulphate-of-iron. 

Bed. If possible have two beds, and night and morn- 
ing change the patient, airing one while using the other. 
Avoid use of feather-beds — too soft a mattress favors bed- 
sores; hair mattress best. Cover mattress with rubber- 
cloth, place over this the sheet, and a small " draw-sheet" 
under the hips. Let the pillows be small, rather hard, and 
so arranged as to support shoulders and expand the chest. 

Nursing. See to it that the nurse gives the patient suf- 
ficient drink to slake thirst. Often when the patient is 
delirious or comatose, this is neglected. Have the sordes 
washed from lips, teeth and tongue with a soft cloth, 
moistened in lemon-water, as often as it accumulates. 
Examine the back and hips daily for redness. If it occur, 
have the spot washed four times daily in alcohol and water, 
dry thoroughly, dust with powder, and use air-cushions. 
Do not permit the patient to stand up. or in any way exert 
himself. 

Bathing. Sponge the entire body several times daily 
with tepid water. If the temperature rise to 103 " in axilla, 
put patient in warm bath. 80 to 90", gradually lower tem- 
perature of bath by cold water till desired effect is pro- 
duced. May have to go to 60% but not lower. If tempera- 
ture fall rapidly remove patient; if slowly, wait till temper- 
ature in axilla reaches 101 . Do not use bath later than 
second week. Cold pack answers same purpose. Spread a 
comfort on bed, over this, blankets, over these a sheet 
wrung out of cold water. Lay patient on the sheet, wrap 
him in it, then fold over him the free edges of the blankets 
and comfort, making all snug. Leave him till sheet becomes 
warm. This is very efficient method of reducing tempera- 
ture. 

Diet. Highly important. Exclusive milk diet best. 
Regularly every two hours give patient a glass of milk, or 
its equivalent at convenient intervals. If milk disagree, i 
try it with lime-water, scalded, iced, or otherwise vary the 
method of administration until a form is found which the 
patient can take and digest. Let the patient draw the 
milk through a bent glass tube. If for any reason patient 
cannot take milk, give other food, being careful to have it 
fluid in form, easy of digestion, and highly nutritious. In 
early days give beef-broth, mutton-broth, chicken-broth; 
later, food which is stimulating as well as nourishing — beef- 
tea, wine-whey, cafe-au-lait, or egg and coffee; again come 
back to broths and gruels after period of depression has 
passed. Vary diet to suit caprice of patient. But remem- 
ber that the milk-diet is superior to all others, and need 
not be departed from if it agree with the patient. IB 



TYPHUS FEVER. g 

Examining Patient. Notice particularly at each visit- 
pulse, nature of heart-beat; state of abdomen: temperature; 
number and character of discharges; respiration, and state 
of lungs. 

Convalescence. Especial care demanded during this 
period. Avoid use of vegetables. No solid food must be 
taken until stools are consistent and fecal. The slightest 
error in diet may e.rcite a relapse. 

TYPHUS FEVER. 
SYNONYMS: Ship Fever ; Jail Fever. 

PROGNOSIS. Always grave. Unfavorable: High 
temperature; frequent pulse; early furious delirium, or 
early stupor: previous debility; in a/coholists usually fatal. 

Favorable: Youth; moderate temperature and pulse, 
and mild nervous symptoms. 

COMPLICATIONS. Pneumonia and swollen parotid 
glands most common. 

CAUSES OF DEATH. May result from meningitis; 
pneumonia: capillary bronchitis: gangrene: asthenia and 
paralysis of the heart; nephritis. 

LKAI)I\(; BEMED1ES. 

Baptisia. Early stage, with high fever and intense char- 
acter of the onset. 

Phosphoric acid. Great nervous depression, with but 
slight febrile excitement or signs of blood poisoning. Com- 
plete apathy and indifference; quiet delirium, with stupe- 
faction, deafness, dull, staring look, epistaxis; distention of 
abdomen, with rumbling and gurgling; watery, grayish 
diarrhoea; thick, cloudy urine: x>rofuse perspiration. Pulse 
weak, small, frequent, intermitting. 

Phosphorus. For a still lower grade of nervous depres- 
sion. Eyes hollow and sunken, frequent and copious epis- 
taxis, dryness of mouth, gums stand off from teeth, and 
bleed easily, vomiting of watery, bilious, or slimy masses; 
loud rumbling and meteorism of abdomen; grayish or 
black discharges, from decomposed blood; roseola spots, or 
echymoses. Also in pneumonic complication, the chief 
remedy. 

•' May save life at the utmost extremity."' Hughes. 

Arsenicum. Intense febrile toxaemia. Great restless- 
ness and anxiety, tongue black, dry and hard, speech unin- 
telligible, excessive thirst, meteorism, involuntary fctools 
and urine, discharges brown, watery, foul; haemorrhage 
from bowels, cold, clammy perspiration and decubitus. 
Also for kidney complications, with suppression of urine. 



10 



KEY NOTES OF MEDICAL PRACTICE. 



Opium. Stupor or coma. 
Merc, biniod., Rhus. Parotitis. 

Rhus, Mur. acid. For milder forms of febrile toxaemia. 
Bell. Headache, cerebral congestion and active deh- 
jium. 

Strain. Delirium so furious as to threaten patients- 
exhaustion. 

GENERAL MEASURES. Typhus being highly con- 
tagious, strictly quarantine the patient, and observe all 
antiseptic precautions. Give abundance of fresh air; 
remove all windows, regardless of cold, and keep patient 
well protected with blankets. Guard against bed-sores. In 
noisy streets, stuff ears with cotton. If temperature rise 
to over 104°, put patient in bath ten degrees below tem- 
perature of body, and gradually reduce temp, of water to 
70°, till bodily temp, falls to 101° or 102 \ If heart's 
action weak, much prostration and feeble circulation, give 
occasional dose of brandy— not more than one ounce in 24, 
hours. • 

Diet. Of greatest importance to aid nutrition. Begin 
early, and give small quantities very nutritious food regu- 
larly and persistently. Milk is the best. Also use beef-tea; 
and broths. If necessary, support by nutrient enemata. 4 

DIFFERENTIAL DIAGNOSIS. 



TYPHOID. 

ENDEMIC. 

Advent insidious, with general 
malaise, headache, chill rare, sev- 
eral days before patient takes to 
bed. 

Temp: little rise at onsot: max- 
imum about 7th day. Exacerbates. 

Eruption, lenticular spots, bright 
rose color. Successive crops. Ab- 
domen. 

Delirium appears late; low mut- 
tering. 

Countenance, pale, olive, leaden. 

Emaciation great. 
Bowels: Tympanites, and "pea- 
soup " diarrhoea. 
Duration 21 to 40 days. 
Terminates by lysis. 



TYPHUS. 

EPIDEMIC. 

Advent, sudden, with intense 
chill, steadily increasing head- 
ache with great prostration. a 

Temp.: 2nd day, 104°: 105° to 
107° on the 3d day; remains high 

to end. 

Eruption, small, slightly ele- 
vate. 1, called " mulberry rank,* 
Remain* throughout disease. 
Sides of chest and extremities. 

Delirium active from first. J 

Countenance, dull, heavy— lafci 

mahogany color. 

Emaciation slight. 

Bou-els: Constipated; no tym- 
panites. 

Duration, 14 days. 

Terminates by crisis. 



CEREBROSPINAL FEVER. 



11 



CEREBROSPINAL FEVER. 

SYNONYMS : Spotted Fever; C.-S. Meningitis. 

PROGNOSIS. Grave. Unfavorable: Extensive haem- 
orrhage into cutis, with marked signs of vital prostration. 
More fatal among infants and young children, than youths 
and adults. Continued rapidity of pulse unfavorable. 
Favorable: cessation of headache; free perspiration. 

COMPLICATIONS: Pneumonia; nephritis; oedema and 
congestion of lungs. 

CAUSES OF DEATH. Asphyxia, from lesion in res- 
piratory nerve-centre ; asthenia ; cedema of lungs ; necraemia. 

LEADIXG REMEDIES. 

Gelsemiuni. Early in the attack. Fever, great languor 
and drowsiness, obscuration of sight, vertigo, respiration 
slow and sighing, pulse soft and feeble, complete loss of 
muscular power. 

In my hands this has been one of the most efficient remedies. 

Verat. vir. Severe frontal headache, violent vomiting, 
pain in stomach, convulsions, retraction of head, opistho- 
tonos, rolling of eyes, dilated pupils, pulse labored, slow 
and irregular. 

" Used with great success in many undoubted cases." Hale. 

Belladonna. Violent headache, drowsiness, delirium, 
cutaneous hyperaesthesia, face red and bloated, boring of 
head into pillow, spasmodic distortion of face, grinding of 
teeth, cold extremities. 

Cieiita. Dilated pupils, staring look, jerking of eyeballs 
and muscles of face, arms and hands, deafness, pale face, 
head retracted, rigid spine, dysphagia, insensibility. 

"Is considered by many to be nearly a specific in this disease." 
Lilienthal. 

Hydrocyanic acid. Fulminant cases. Patient stricken 
down suddenly, loss of consciousness, dyspnoea, gasping, 
small pulse, purple face, tonic spasms, low moaning, flut- 
tering pulse. 

Hyos. Delirium and convulsions. 

Opium. Face bloated, eyes fixed, half-closed lids, deep, 
slow breathing. 

Actea. Spasms continue after acute symptoms have 
subsided. 

Arsenicum. Septic symptoms, foul discharges from the 
bowels, signs of decomposition of blood, petechia?. 
Rhus, Bry. Typhoid-like state, low fever, etc. 

GENERAL MEASL T RES. Most important to get up 
free diaphoresis early. Put patient into a hot bath — 104 - 
106° — for a short time, then wrap in warm blankets until 



12 



KEY NOTES OF MEDICAL PRACTICE. 



ffve perspiration is induced. Repeat if skin again becomes 
dry and hot. Ice-bag to head. 

Diet. Give concentrated liquid food freely, — milk, beef- 
tea, broths. Nourish by enemata, if patient cannot take 
food by the mouth. 

Look to state of sewage and drainage, and provide for 
good ventilation of the dwelling. Observe great care 
during convalescence; relapses generally fatal. 

SIMPLE CONTINUED FEVER. 
SYNONYM: Gastric fever. 

PROGNOSIS. In absence of complications, always 
favorable. 

Baptisia. Chilliness, fever, violent headache, great lan- 
guor, loss of appetite, great thirst, thick, white coating on 
tongue, nausea, vomiting, epigastrium and abdomen sensi- 
tive, constipation, with later diarrhoea. 

"Baptisia is a true specific. Defervescence and crisis will follow its^ 
use in a very short time." Hughes. 

Arsenicum. Later in disease, the tongue dry ancfl 
brownish, abdomen distended, great thirst, prostration, 
restlessness, diarrhoea, burning pains in stomach, pale face, 
cold extremities. 

Bryonia. Vertigo, nausea and faintness on sitting up, 
fullness in forehead, as if everything would be pressed out, 
splitting headache, lips parched, dry and cracked, tongue 
coated, constipation; great irritability. 

Mercnrins. Pale, yellow, earthy color of face, tongue 
thick, yellow coating, fetid breath, gums swollen, profuse 
secretion of saliva, region of stomach sore to touch, dark- 
red urine, diarrhoea. 

Ant. tart. Empty or putrid eructations, constant 
nausea and inclination to vomit, loss of appetite, loathing 
of food, great secretion of mucus, apathetic state, exces- 
sive debility and prostration, alternate mucous diarrhoea 
and constipation. 

CONSULT— Nux v., Puis., Iris, Ipec. 

GENERAL MEASURES. Plain andsimple food mud 
be given, as every error in diet is apt to cause a relapse. 1 



ERUPTIVE FEVERS. 

The Eruptive Fevers are distinguished by a liigh 
degree of contagion, a period of incubation, intense fever, 
a characteristic eruption, and immunity after one attack. 



ERUPTIVE FEVERS. 



SCARLET FEVER, 
SYNONYM: Scarlatina. 

PROGNOSIS. Depends upon character of prevailing 
epidemic. In severe cases, always uncertain. Unfavorable : 
Temperature of 105°+; dyspnoea; cold surface; livid hue of 
eruption; suppurative pharyngitis; persistent vomiting; 
complete suppression, of urine. Also bad in the very young, 
in organic disease, and if complicated. 

LEADING REMEDIES. 

So. Simplex. Ac, Bell., Rhus. 

So. Allginosa. Apis., Merc, iod., Amm. Curb.. Ac. Mur., 
Lach. 

Sc. Maligna. Ailanth., Ars., Ac. Mur., Cup. Acet., Rims. 

Aconite. Has a limited use early, to subdue arterial 
excitement. 

Belladonna. In sthenic form, the eruption smootli and 
shining, with great vascular and nervous excitement. Con- 
gestion of brain and delirium, throbbing of carotids, eyes 
injected, face fiery red, tongue white, with red edges, or red. 
with raised papilla?; fauces and tonsils inflamed and 
swollen; external swelling of neck. Of no benefit in 
adynamic cases. 

Rhus. Scarlatina simplex, when eruption is miliary, 
the rash being interspersed with fine red points, and some- 
times fine vesicles. Also, in the adynamic form, erup- 
tion dark, eyes swimming, tongue dark brown and dry. lips 
and teeth covered with sordes, drowsiness, low, muttering 
delirium, epistaxis, swollen parotids, and thin, offensive 
discharges from bowels. 
I have used Rhus in these cases with great success. 
Apis. Fever of low type. Tongue deep-red and covered 
with blisters, tonsils ^edematous, swollen and ulcerated, 
abdomen sore to touch, slimy and bloody discharges from 
bowels, urine scanty and dark-red, micturition frequent 
and painful, loss of consciousness, delirium, sopor. Also 
for tedema and dropsy. 

Amnion, carb. Swelling of parotid and lymphatic 
glands of neck, throat dark-red, with tendency to gangre- 
nous ulceration. 

Merc. iod. Much glandular swelling, with stiffness and 
pain, salivation, fetor of breath, rapid- and great prostra- 
tien, commencing ulceration of throat. 

Ailanthns. Malignant cases, the patient being suddenly 
taken with violent vomiting, severe headache, intolerance 
of light, hot, dark-red face, rapid, small pulse, high temper- 
ature, drowsiness, muttering delirium, dark, livid, miliary - 
rash, in patches. 

"Directly specific, and of eminent value.'' Dr. Mddden. 



14 



KEY NOTES OF MEDICAL PRACTICE. 



Arsenicum. The eruption grows suddenly pale, skm 
cold, small pulse, rapid prostration, putrid sore-throat, 
great restlessness, dyspnoea; fetid, involuntary discharges 
from the bowels. 

Cuprum acet. Sudden retrocession of eruption, fol- 
lowed by vomiting, convulsions, rolling of eyes, distortion 
of face, sopor and delirium, signs of metastasis to brain. 

" Employed with gratifying success." Dr. Drummond. 

Muriatic acid. Malignant cases. Severe ulceration of 
throat, fetid breath, acrid discharges from nose, soreness 
and vesicles about nose and mouth, eruption faint and 
livid, flushed cheeks, eyes dull red. 

Lachesis. Throat swollen, ulcerated, livid, great fetor 
of breath, the system seeming to be re-inoculated from the 
ulcerated sore-throat, with general prostration, quick, fee- 
ble pulse, low, muttering delirium, and jactitation. 

" It has never disappointed me." Hughes. 

Cuprum acet. Retrocession of eruption; quick, small, 
irregular pulse, low temperature, sopor, rolling of eyes, 
facial distortion, spasm of various muscles, cold face, blue 
lips, convulsions. 

Retrocession of eruption. — Ars., Cup. acet, Camph. 

When the fever degenerates into a low, typhoid-like con- 
dition. — Rhus, Ars., Lach. 

Stage of desquamation. — Ars., Sulph. 

Nephritis and dropsy. — Ars., Apis, Tereb. 

Discharges from ears. — Ac. mur., Hep.-s., SiL, Graph., 
Merc. dulc. 

Discharge from nose. — Ac. mur., Aur., Ars. 
Inflammation of eyes. — Aeon., Sutyh. 
Glandular Swellings. — Rhus, Lach., Merc. 

GENERAL MEASURES. Quarantine patient, and re- 
move other children. Put patient in an upper room, large, 
ivell-ventilated, and free from upholstered furniture and 
drapings. Use all antiseptic precautions with clothing, 
utensils, and discharges. Sponging body frequently with 
tepid water moderates fever, allays restlessness and favors 
sleep. Promote free action of skin. Watch state of urine, 
and anticipate kidney complication. Use caution until 
recovery is fully established. 

Diet. Light and nutritious. Milk, broths, gruels, 
toast, etc. Drinking large quantities of water favors 
action of kidneys. Jn low cases feed as in typhoid. 

MEASLES. 
SYNONYMS: Morbilli; Rubeola. 

PROGNOSIS. If uncomplicated, favorable. 
Unfavorable: — In tuberculous subjects, and cachectid 



MEASLES. 



15 



constitutions; black-measles; complicated by epistaxis, 
diphtheria, capillary bronchitis, or broncho-pneumonia. 

L£ADI\G REMEDIES. 

Aconite. High temperature and other febrile symptoms 
— hot skin, red eyes, intolerance of light, general malaise. 
In simple cases, the only remedy required. 

Pulsatilla, Eyes red and watery, sensitive to light, 
thick, yellow discharge from nose, dry mouth, no thirst, 
loose cough, rumbling in bowels, and diarrhoea. 

"Of high repute for the diarrhoea.*' Huglies. 

Euphrasia. Streaming of hot, burning tears from the 
eyes, with great photophobia: profuse running from the 
nose, without burning. 

" Invaluable for the nasal and conjunctival catarrh." Hughes. 

Bryonia. Eruption retarded, or retrocession of erup- 
tion, with oppression of chest and laborious breathing. 
Dry cough, with shooting pains in chest. 

" Remarkably successful in bronchitis." Jousset. 

Ipecac. Eruption retarded or suppressed, with nausea 
or vomiting, and rattling of mucus in the chest. Will gen- 
erally stop the epistaxis. 

Verat. vir. Convulsions before the eruption. Conges- 
tion of lungs during febrile stage. 

Arsenicum. Adynamic and malignant cases. Burning 
heat of skin, quick, small pulse, great anxiety, restlessness, 
sudden retrocession of rash, pale, bloated face, great sink- 
ing of strength. 

Camphor. Rubeola Fulminans. Face grows suddenly 
pale, skin cold and purple, stiffness of body, utter prostra- 
tion and collapse. Give drop doses, frequently repeated. 

SPECIAL REMEDIES. 

Phos. Bronchitis or pneumonia. 

Rhus. Low fever, dry, brown tongue. 

Kali bi. The hoarse, laryngeal cough. 

Cupr. acet. Retrocedent, affecting brain. 

Bell. Cerebral congestion or sore throat. 

Slll|>ll. To promote recovery; strumous subjects. 

Merc. Glandular swelling, ulcerations, dysentery. 

GENERAL MEASURES. Quarantine patient. Room 
well ventilated, with even temperature. Darken room 
while eyes are sensitive. To relieve itching and burning of 
skin, cool water spongings. Warm bath to bring out 
delayed eruptions. If temperature rise to 103 -104% reduce 
by cool sponge-baths. Protect patient against cold air and 
sudden changes of temperature, and keep chest well pro- 
tected. Diet of milk and broths. 



lfi KEY NOTES OF MEDICAL PRACTICE. 

SMALL-POX. 
SYNONYMS: Variola; Varioloid. 

PROGNOSIS. Depends on type of disease. In V. . 
discreta, uncomplicated, favorable In V. confl uen tes, grave. 
Unfavorable:— In the intemperate: syphilitic; extremes of 
life (recovery rare after 60); lung complications; inflamma- 
tion of skin between pustules; epistaxis and other hiemor- 
rhao-es: scanty urine early: intense secondary fever, 
between ninth and twelfth days. In V. ha-morrhaaiea 
recovery rare. 

CAUSES OF DEATH. — (Edema glottidis: general 
bronchitis; pneumonia; acute fatty degeneration of 
kidneys; asthenia. 

LEADING REMEDIES. 

Variola Disoketa. Bell., Ant. tart. Sulph. 

Variola Confluentes. Sulph.. Ars., Phos. 

Variola Hemorrhagica. Phos., Ars.. Loch. 

Ant. tart. One of the most useful remedies; it reduces 
the fever, the pustules run their normal course. It is also 
especially useful in pulmonary complications, and for 
gastric disturbances. Given early it mitigates the severity 
of the disease. 

Belladonna. High fever, severe local symptoms, throb- 
bing carotids, injected eyes, photophobia sore throat, 
severe pain in back, starting and jumping in sleep, 
delirium. 

Merenrins. Maturation impending, and suppurative 
fever rising. Moist, swollen tongue, ulcerated throat, fetid 
breath, profuse flow of saliva. Dysenteric discharges from 
bowels. 

Arsenicum. Hemorrhagic variola. Eruption dark, skin 
blue or livid, great sinking of strength, small, frequent 
pulse, extreme thirst, anguish and restlessness. 

Actea. Early stage; severe pain in back and eyes, head- 
ache, sore, bruised pain all over, exhaustion, nausea. 

Hydrastis. Great redness, swelling and itching of the 
skin! with very sore throat. Intense aching in small of 
back and legs. Especially useful when ulcers occur on 
mucous membrane of mouth and fauces. 

Sulplmr. Disease pursues an irregular course, pustules 
become purple or black. Also for period of dessication. 

SPECIAL REMEDIES. 

Pneumonia. Ant. tart, Pin,*. 
glandular Swellings. Mere. iod. 
Low, Typhoid State. Bapt, Ars. 
Congestion of Lungs. Verat. vir., Aeon., Bry. 



SMALL-POX. 



17 



Boils. Hep. s., Sulph., Phos. 
Ophthalmia. Merc, con-., Sulph, 
Delirium. Bell., Strum.. Verat. r. 
Dropsical Swellings. Apis., Ars. 
Repercussion of Eruption. Campk., Ars., Sulph. 

GENERAL MEASURES. Complete isolation. Vac- 
cinate patient, if this had never been done. Free ventila- 
tion of apartment highly important. Should be attended 
by one who has already suffered from the disease. Cleanli- 
ness and disinfection of strictest kind. In cold weather, 
keep patient well covered, fire in room, but windows wide 
open. Guard against bed-sores. Give patient frequent 
sponge-baths. Do not injure pustules. Let adults wear 
loose gloves, and bind the hands of children, to prevent 
scratching. To prevent pitting, keep patient in dark 
room, protect pustules from injury, and keep each one well 
anointed with Vaseline and flour, made into a paste. 
Cold water compresses to face and hands often allay the 
burning pain. If ulcers in mouth and throat, let patient 
take bits of ice, and use mild Hydrastis gargle. 

Clothing. After the attack, destroy all clothing, and 
fumigate room. 

Diet. From beginning, give sustaining diet of milk, 
eggs, animal broths, oysters, and beef-tea every three 
hours. F>-esh. ri/>e fi-uits allowable if bowels not affected. 
For drink, give iced milk, or if this does not agree, lemon- 
ade, or raspberry-vinegar water. 



VACCINATION. 

Caution. Be sure to use only a pure article of bovine 
virus. Keep in cool place in a tightly-corked vial. 

Scrape the skin in three places till true skin is reached 
and ready to bleed, but without any flotv of blood. 
Moisten the virus, and rub it well over the ra*v surfaces. 
Or, make several slight horizontal and transverse cuts, 
crossing each other, and rub the virus over these. Let it 
thoroughly dry, or, put piece of plaster over. If the vac- 
cination " takes " — 

3rd da u. — Papule appears. 10th day. — Areola begins to fade. 

6'ft day.— Vesicle, with central Jlt'i day. — A brown, mahogany 
depression. crust has formed. 

8th day. — Vesicle distended with 23rd day. — Crust becomes de- 
lymph, and has wide, tached. 
red areola. 

The fever which sometimes accompanies may be met by 
Belladonna. 

Vaccination should be performed at least twice — in 
infancy and at the age of puberty. Also, whenever expos- 
ure is liable to occur. 



18 



KEY NOTES OF MEDICAL 



PRACTICE. 




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INTERMITTENT FEVEK. 19 

DENGUE. 
SYNONYM : " Break-bone Fever." 

PROGNOSIS. Favorable, except in the aged, and 
in feeble infants. 

LEADING REMEDIES. Gels., Bry., Eup., Rhus, 
Actea, Ars. 

PERIODICAL FEVERS. 

Periodical Fevers are marked by intervals in the 
course of the disease during which the patient is almost 
or quite free from fever. 

INTERMITTENT FEVEK. 

SYNONYM: kgue. 

JLEADlXCc REMEDIES. 

Cinchona. Recent cases. Paroxysm- preceded by head- 
ache, hunger, palpitation. Each stage well-marked — first 
the chill, which is severe, and the principal feature of the 
attack, with violent shivering and aching pains; then the 
fever, followed by violent thirst and sweat which is some- 
times profuse and exhausting. Apyrexia: — Patient suffers 
but little — feels almost in ordinary health. 

Dose. — First decimal, or centesimal, trituration, two or 
three grains every three or four hours in apyrexia. — 
Hughes, Baehr, Panelli, Jousset. 

"Undoubtedly the most important remedy." Baehr. 

Arsenicum. Attack preceded by weariness, approaching 
prostration. Paroxysm imperfectly developed. Before 
chill, vertigo, headache, yawning, stretching, and general 
sense of discomfort. Chill and heat inter-mingled; 
oppressed breathing, nausea, sometimes vomiting; small, 
feeble pulse, even during hot stage. One of the stages 
often absent — sometimes the sweat, but usually the chill. 
Tendency to increase in the severity of the paroxysms, 
and rapid and excessive prostration. Urgent thirst through- 
out. Apyrexia: — -Prostration, nausea, pains in stomach 
and bowels, dropsical swellings. 

Ipecacuanha. Backache, short chill, long fever. Nau- 
sea, vomiting, and other gastric disturbances, occurring 
before and during chill and heat; tongue thickly coated 
with yellowish, moist fur; great oppression of chest. 
Nausea and vomiting predominate. Apyrexia: — More or less 
gastric disturbance. 

" Useful in mild forms of tertian." Baehr. 



KEY NOTES OF MEDICAL PRACTICE. 



Nux V. Chill, long-lasting and hard, fever severe, sweat 
profuse; both chill and fever accompanied by much gastric 
and bilious disturbance. Distressing pains in head, back, 
and legs. During chill external warmth aggravates and 
causes shivering. 

" Nux, hi alternation with Ipec, for impure intermittents iu non- 
aguish districts." Hughes. 

Natr. mm*. 30 Chill beginning in feet or small of back; 
blue nails, thirst, bursting headache, relieved by sweating. 
Bilious chill. Bilious vomiting before and during chill. 
For severe cases Dose: — " I am compelled to declare my- 
self for the higher dilutions." Dr. Watzke. 

" One of the most powerful remedies." Mitchell. 

Eupator. perf. Thirst several hours before chill, con- 
tinuing during chill and heat. Chill short, hot stage pro- 
tracted, and sweat slight. Vomiting of bile at end of chill. 
During chill and heat back aches violently, as if it would 
break. 

Veratrum alb. Predominance of external coldness; 
cold, clammy perspiration; great thirst, especially during 
chill and sweating. Great exhaustion and sinking of 
strength. Vomiting and diarrhoea, with griping, and pain 
in back and loins. 

"Indicated in the most pernicious kinds." Raue. 

Phos. ae. Profuse sweat. 

Gels. Severe nervous symptoms. 

Aeon. Recent cases in plethoric subjects. 

Cedron. Chills recur with marked regularity. 

Ign. Chill relieved by external warmth. Thirst only 
after paroxysm. 

Caps. The sweat coincides with the heat instead of 
following it. 

Puis. Gastric symptoms and resulting chlorosis and 
hydraemia. 

HydrastlSi Cachectic subjects with hepatic and gastric 
symptoms. 

A vs.. Ipec.. Cedr., Slllph., for dumb-ague. 
Chinoidine will often cure when Quin. sulph. fails. 

GENERAL MEASURES. During paroxysm, give 
Aeon, to mitigate severity. Apply artificial heat during 
chills, cooling drinks during hot stage, and warm, dry linen 
after sweat. 

In malarial districts, avoid out-door air after sundown; 
sleep in upper room. 

REMITTENT FEVER. 

SYNONYM: Bilious Fever ; Typho-malarial Fever. 
PROGNOSIS. Favorable. 



PERNICIOUS AGUE. 



LEADING RKHKDI BOSS. 

Belladonna. For initiatory fever. Severe chill, with 
vomiting and retching, violent fever, which is especially 
high at night. 

Gelsemium. Congestion of head, flushed face, chilliness, 
languor, great muscular -weakness, pulse full, quick and 
soft; dull pain in head, back and limbs. 

China. Great prostration, fluctuating pulse, humming 
in the ears; marked remission. 

Ipecacuanha. Gastric disturbance, headache, yellow or 
white coated tongue, bitter taste, vomiting and continued 
nausea. 

Mfepcurius. Thick, yellow, pasty coating on tongue, 
earthy color of face, bitter taste, soreness in liver. 
•' Applicable (luring greater part of disease." Baehr. 

Bryonia. Pressive or tearing pains in chest, better 
When at rest. Thin coating on tongue, bitter taste, consti 
pation. Distinctly marked febrile motion. 

Pulsatilla. "Whitish coating on tongue, bitter eructa- 
tions, bitter vomiting; chilliness; thirstlessness. 

Rhus. Fever degenerates into a low, typhoid state, with 
adynamia, diarrhoea, tongue brown and dry, sordes on lips, 
teeth and tongue. 

Arsenicum. Great emaciation, prostration and restless- 
ness, with intense thirst; dark, fetid discharges from the 
bowels. 

GENERAL MEASURES. Sometimes degenerates into 
low " typhoid " condition, when nursing and diet should be 
similar to that recommended for Enteric Fever. 

PERNICIOUS AGUE. 

SYNONYM: " Congestive Chili:' 

VARIETIES : -Cerebral | Gastroenteric {fljjjfc 

PROGNOSIS. Grave. Recovery rare if more than 
two paroxysms occur. 

" I have never lost a patient except where there has been an evideut 
heart affection— a fatty condition or dilatation— or where an organic- 
brain lesion has occurred during the first chill." J. P. Bake. 

TREATMENT. Must be prompt and vigorous. Bring 
about re-action as soon as possible. In cold stage, heat to 
surface, with stimulants. When cerebral congestion, cold 
affusions to head. 

LEADING UEJIEUIKS. 

Arsenicum. Cold, clammy sweat, breath cold, eyes sunk 
in sockets, Hippocratic countenance, great prostration, with 
great anguish, thirst and restlessness. 



22 



KEY NOTES OF MEDICAL PRACTICE. 



Veratmm vir. Intense cerebral congestion; delirium; 
face purple; violent throbbing of carotids; pulse full, 
hard, and bounding. 

" Especially when the congestion involves (he brain, and the chill has 
been severe anil profound." J. P. Dake. 

Grelsemium. Burning heat of the surface, great sensi- 
tiveness to light and sound; delirium; predominance of 
nervous symptoms, with great muscular weakness. 

" When brain and spinal cord are both pressed, and heart's action 
irregular." J. P. Dake. 

Quill. SUlph. Must be freely given to bring about 
reaction. Give grs. v. every two hours, or grs. iij every 
hour, till signs of reaction appear, then grs. ij every three 
hours till the time for another paroxysm is past. Capsicum 
(inn., one-fourth part, may be advantageously combined 
with the Quinia. 

If dose cannot be given by stomach, administer subcu- 
taneously * 
Lente's Solution 



Ij. Bisulphate of quinine. 50 grains. 

Dilute sulphuric acid, 1 drachm, 

Carbolic acid, liq., 5 minims, 

Water, to make, 1 ounce. 



Dissolve the bi-sulphate in the sulphuric acid and water, 
by the aid of heat; filter, and add the carbolic acid. Ten 
drops contain one grain of the bi-sulphate. 

" Subcutaneous injection is the quickest and most powerful means of 
bringing the patient under the influence of quinine." Bartholow. 

Solution of Sulphate of Quinine. 



Ij. Sulphate of quinine, .30 grains, 

Sulphuric acid, dilute. sufficient, 

Water, 2 ounces. Mix. 

Give in sj 7 rup of licorice. 



" Quinine is called for in some cases— perhaps at some stage in oH 
cases— and no other remedy can take its place." J. P. Dake. 

" The prompt and energetic administration of Quinine is impera- 
tively demanded." L. A. Falligant. 

" My treatment is Quinine, Quinine, Quinine." W. H. Holcombe. 

"Quinine is the remedy par excellence.'''' A. Cha rge. 

GENERAL MEASURES, During the congestive chill, 
use free, hot foot-baths and mustard draughts to the 
extremities, to divert the circulation. If intense conges- 

, tion of the head, use cold affusions — but do not use them 
if face be pale. If there be great prostrat 'ion, prof use, cold 
perspiration, cold breath, give stimulants — feed the patient 
with brandy or whisky, mixed with finely-pounded ice if 
there be great thirst. 

" Remissions greatly promoted by free and frequent use of hot mus- ' 

. i tard foot-bath. Prostration and exhausting sweat demand sthuularitR " 
— Falligant. ■ J 

k 1 



YELLOW FEVER. 



23 



YELLOW FEVER. 
SYNONYM: Febris Icterodes. 

PROGNOSIS. Favorable: Free, copious urine, how- 
ever dark or bilious it may be. most favorable of any single 
sign. 

Unfavorable: Blood in the. early vomit; black vomit; 
faltering articulation; suppression of urine. 

LEADIXG REMEDIES. 

FIRST STAGE. 

Camphor. Initiatory chill, severe and long-lasting, with 
great coldness of skin and prostration. Dose: Drop doses 
of tincture every ten minutes. 

Aconite. First stage, after reaction from chill; fever, 
burning heat, dry skin, full, hard and rapid pulse, violent 
thirst, red face, headache, restlessness, prostration and 
vomiting. 

Belladonna. Cerebral congestion, headache, throbbing 
of carotids, face scarlet-red, shining and swollen, eyes red 
and sparkling, active delirium, pain in stomach, with 
nausea and vomiting. 

" Aeon, and Bell, are complements of each other in stage of fever and 
cerebro-spinal irritation, and I therefore use them in alternation, every 
half hour at first." Holeombe. 

SECOND STAGE. 

Bryonia. After cerebro-spinal symptoms have subsided, 
and the gastric symptoms are prominent. Splitting 
headache, eyes red, sparkling, tongue yellow-coated, lips 
parched, dry and cracked, great irritability and vomiting. 

Argentina nit. Vomiting of brownish mass, mixed 
with coffee-ground-like flakes. 

"]f the patient sinks, if the vomiting becomes worse, or with any of 
those various signs which indicate haemorrhage from the gastric 
mucous membrane, Arg. nit. is the remedy." Holeombe. 

THIRD STAGE. 

Arsenicum. Face yellowish and livid, eyes dull and 
sunken, nose pointed, lips and tongue brown or black, 
burning or stitching pain in epigastrium and region of 
liver, suppression of urine, oppression of chest, short 
anxious breathing, pulse small and tremulous, skin cold, 
cold clammy perspiration, rapid prostration, and vomiting 
of a brown, turbid matter, mixed with mucus, and some- 
times stained with blood. 

Lachesis. Delirium, slow, difficult speech, red face, 
tongue heavy, trembling, dry and brown ; nausea, vomiting, 
irregular, weak pulse, urine almost black. 

" When Bell, and Aeon, produce no further amelioration, a change to 
Ars. and Loch, brings about the desired amendment." Holeombe. 



KEY NOTES OF MEDICAL PltACTICE. 



Crotalus. Haemorrhages from eyes, nose, mouth, stom- 
ach, and intestines— from all the orifices of the body, even 
to bloody sweat. 

" Has proved of excellent service." Neidhard. 

SPECIAL REMEDIES. 

Sab.. Sec. Threatened abortion. 

Hyos.. ('off. Nervous sleeplessness at night. 

Allt. tart. Prolonged and incessant nausea. 

Verat. alb. Vomiting and abdominal pains. 

Phos.. Merc. Resulting diarrhoea or dysentery. 

Ipec. Continued nausea; vomiting of glairy mucus. 

Canth. Cramps in abdominal muscles and legs, with 
frequent urging to urinate, or, suppression of urine. 

" Scarcely ever fails to remove strangury and restore the renal 
secretion." Holcombe. 

GENERAL MEASURES. Quarantine patient; use 
disinfectants; keep patient quiet, in horizontal posture: 
keep air fresh and pure; cool sponging of body when fever 
high. 

Diet. Requires strict attention. First stage, milk and 
water, with lime-water added, black tea. with cream; ice- 
cream; bits of ice, to slake thirst, and allay vomiting. 
Later, give rice, milk, and arrowroot. During stage of 
prostration, beef-tea, wine-whey, cafe-au-lait. Great cau- 
tion necessary, lest an error in diet excite a relapse. 



DISEASES OF RESPIRATORY ORGANS. 
OOEYZA. 

SYNONYM: Nasal catarrh. 

Camphor. Incipient stage, chill. Drop doses, fre- 
quently repeated, often cut it short. 

Aconite. Chilliness, followed by feverishness, as pre- 
cursor of catarrhal fever. 

Euphrasia. Acrid, fluent coryza. with scalding tears 
and aversion to light. 

Arsen. iod. Abundant discharge of thin, hot. excoria- 
ting mucus from nose, with burning sensation; lassitude 
and prostration. 

Merc. iod. Frequent sneezing, soreness of nose, dis- 
charge of thick mucus; great accumulation in posterior 
nares; salivation; sore throat; profuse perspiration. 

Hydrastis. Thick, tenacious secretion from posterior 



OZCENA — (EDEMA GLOTTIDIS— EPISTAXIS. 



iiares, constantly dropping into throat. Also, p spray, 
locally, of Muriate of Hydrastis. 

Kali Inch. Chronic coryza, with tough, stringy mucus, 
hoarseness, cough; yellow-coated tongue and gastric dis- 
turbance. 

OZ(ENA. 

Auruiu. Discharge offensive; bones of nose sore; melon 
cholia; mercurialization; syphilitic subjects. 

Nitric acid. Syphilitic ozaena; also after drugging with 
large doses of Mercury. 

Kali bich. Thick, tenacious, sometimes bloody discharge, 
and "plugs" of thick mucus. 

Pulsatilla. Soreness of nostrils, with greenish dis- 
charge. 

GENERAL MEASURES. Local applications, admin- 
istered by means of atomizer, should be made to affected 
part. If discharge very offensive, use solution Kali per- 
mang., grs. v. to oz. warm water; or Carb. acid gtts. v., 
Iodine gtts. vi., to oz. water. In severe cases of ozaena, 
ointment of red-precipitate (H7dr.-pr8Bcip.-rub.) may be 
applied directly to the sores, whenever they can be reached 
in the nasal cavity. 

(EDEMA GLOTTIDIS. 
Apis niel. Sudden oedema of glottis. 

" Trust to Apis — it ha.- cured it iu its most fatal form.*' Hughe*. 
CONSULT — Ars., Sang., Strain. 

GENERAL MEASURES. Scarify glottis with point 
of guarded bistoury; or, with finger-nail sharpened to a 
point. Inhalations of steam. Tracheotomy, if suffocation 
imminent. 

EPISTAXIS. 

Aconite. Prolonged or violent bleeding in plethoric 
subjects, witli fullness of cerebral vessels. 

Belladonna. Congestion of head, blood bright and 
flowing freely. From being over-heated. 

Arnica. From injury. Nose feels hot. blood red and 
liquid, haemorrhage preceded by itching or tingling of 
nose. 

Carbo. veg". Severe nose-bleed, several times daily for 
weeks, face pale before and after each attack. Aged per- 
sons, bleeding profuse and persistent. 

Nitric ac. Disposition to nose-bleed; severe and fre- 
quent attacks. 



! 26 



KEY NOTES OF MEDICAL PRACTICE. 



China. Weakly persons who have lost much blood — 
ringing in ears, pale face. 

Bryonia, Bleeding of nose when menses should appear. 

Hainamelis. Passive flow, blood dark and liquid; hem- 
ophilia. 

Ferrnm. phos. Epistaxis in old people. 

GENERAL MEASURES. Raise the arms above the 
head. Apply cold water or ice to root of nose, or back of 
neck. Insert into the nostril plug of lint saturated with 
Hamamelis. Inject into nostril solution of alum. (See 
Part III.) 

HAY-FEVEE. 

SYNONYMS: Hay Asthma; Rose Cold. 

Arsenicum. The leading remedy. Its persistent use 
has cured some cases. 
S^ticta pulm. "I have used it considerably, and with the very 

best results." Dr. B. F. BaiJey. 

Ipecacuanha. In conjunction with Ars., especially when 
asthmatic symptoms prevail. 

Sabadilla. Hay fever with violent sneezing and running 
of eyes and nose. 

" I have cured a number of severe cases." Bayes. 

Quinine. Use solution locally. 

11 With Binz's solution quinine as local application I have had very 
good results." Hughes. 

GENERAL MEASURES. Change of climate assures 
immunity. Mackinac, and the shores of Lake Superior, 
the White Mountains, favorite resorts. Sea voyage also 
effectual. To stop violent paroxysms of sneezing, plug 
nostrils with cotton— not tight, but so that the air. in breath- 
ing, will filter through. 



INFLUENZA. 

Arsen. iod. Chills, with flushes of heat; severe, fluent 
coryza, discharge irritating and corrosive; sneezing- puffi- 
nessofface; prostration. °' 

" The specific remedy." Hughes. 

Aconite. High fever, hot, dry skin, restlessness, dry, 
violent, racking cough, with stitches in chest. 

Mercurius. Rheumatic pains in head, face, ears, teeth 
and extremities; fluent coryza, with catarrh of throat and' 
lungs, with violent, racking, unceasing cough; chill and 
heat, with profuse, non-alleviating sweat. 

Eiipatorium pert". Distressing backache and "bone- 
pains." 



CROUP. 



27 



Kali l)i. Troublesome cough, with coated tongue and 
loss of appetite. 

GENERAL MEASURES. In severe cases, confine- 
ment to bed, with warm drinks, and a hot-bottle sweat will 
greatly aid. If cough severe, keep atmosphere of room 
moist. 

CROUP— CATARRHAL. 

SYNONYM: Acute Laryngitis. 

Aconite. Early in attack, short, dry, hard, metallic 
cough; hurried, labored breathing; hot, dry skin; thirst; 
restlessness. 
This is the principal remedy for catarrhal croup. 

Spimsria. Rough, crowing, barking cough; loud, wheez- 
ing, sawing respiration; suffocative fits; inability to 
breathe, except with head thrown back. 
With Aconite, sufficient in most cases. 

Hepav s. Loose, rattling, choking cough. Air-passages 
seem to be clogged with mucus. After resolution has been 
initiated by Aconite and Spongia. so that the breathing has 
a rattling rather than a sawing sound. 

Kali hi. The throat becomes filled with tough, tenacious 
mucus. 

Phosphorus. Hoarseness after croup, with tendency to 
relapses. 

Ant tart. Loose cough, mush mucus on the lungs, 
with difficult expectoration. 

GENERAL MEASURES. Hot fomentations to the 
throat, and hot foot-bath, up to the knees, often benefit 
Give patient plenty of fresh air. Give frequent doses of 
indicated remedy. 

CROUP— PSEUDO-MEMBRANOUS. 

PROGNOSIS. Grave. Unfavorable: Signs of car- 
bonization of the blood — face becomes blue, hands cold 
and fingers blue under nails, with drowsiness and stupor. 
Pulse weak, small, irregular and frequent. Cold ex- 
tremities. 

liEADIXO REMEDIES. 

Iodine. Dry, short, barking cough, with wheezing, saw- 
ing respiration, imminent suffocation and extreme dysp- 
noea. Dose. Teste uses a one per cent, solution, three 
drops every fifteen minutes. 

" As soon as I am satisfied of the existence of true croup, I give 
Iodine, second dilution." Dr. Elb. 



KEY MUTES OF MKDIOAL, PRACTICE. 



Bromine. Child gasping for air, rattling of mucus in 
windpipe when coughing, false membrane extend ing to 
lungs, great prostration. 

" Constitutional prostration is the characteristic indication for the 1 
preference of Bromine— Iodine suits the more sthenic form." — Hughes. 

Kali bi. Gradual onset, hoarse, dry, barking cough; 1 
tonsils and larynx red and swollen, with patches of pseudo- 4 
membrane; violent wheezing and rattling in trachea, mem- 
brane thick and tenacious. 

" Has frequently cured membranous croup." Hughes. 

SPECIAL REMEDIES. 

Bell. Early, as anti-pyretic, and to reduce the local ca- 
pillary congestion. Mitchell. 

Arsen. Great puffy swelling of throat and neck, putrid j 
breath, rapid and extreme prostration. 

Phos. Increased dyspnoea, agony 7 and restlessness, J 
hollow cough, the croupous process extended to bronchi, i 
the lungs hyperasmic. 

Ant. tart. Danger of asphyxia occasioned by movable 
patches of membrane, cough feeble and without resonance, 
mucous rale in trachea. 

Hep. s. After the attack, a rattling cough remains. 

Phos. Dry cough remaining after recovery. 

GENERAL MEASURES. Give the patient an abun- 
dance of pure air. Keep temperature of room at 70° F., 
and atmosphere moist. Early in attack bits of ice are ] 
grateful to the patient. Give inhalations of the indicated 
remedy. Iod., Brom., Kali bi., by means of the steam | 
atomizer, in addition to its internal administration. 

Tracheotomy. The percentage of recoveries following 
tracheotomy is such as to demand its trial in every critical 
case. The operation is called for ivhen there is considerable j 
false membrane in the larynx, when respiration is so difficult j 
that you see falling in of the sternum each time the 2iatient 3 
breathes, and each supra-clavicular space deepens with J 
every inspiration. (For method of operating see Part III.) 

Diet. Give nourishing food, liquid in form— broths, 
beef-tea, milk, eggs stirred in milk, wine-whey, egg-coffee; 
or, nutrient enemata. 

COUGH. 

Nitric ac. Chronic, laryngeal cough, without expectora- 
tion, with stinging and smarting as of small ulcer in 
larynx — generally on left side. 

"I have lon<? used it with benefit in dry and violent larvns?eal 
coughs." Hughes. J^S 00 ? 

Hepar s. Irritating cough, with hoarseness, excited by 



WHOOPING COUGH. 



29 



exposure to cold. Rattling of mucus in throat. Sensation 
as of a clot, of mucus, or internal swelling, when swallowing. 

Phosphorus. Dry cough, excited by tickling in the 
throat, with hoarseness. Phthisical cough, in those with 
weak lungs. 

Spongia. Dry, hoarse cough, with pain in larynx, worse 
at night. 

Stilphm*. Dry cough, with hoarseness and dryness in 
throat, and tightness of chest. Or, loose cough, with ex- 
pectoration of whitish or yellowish mucus. 

Kali bieh. Cough with tough, stringy expectoration, 
preceded by much wheezing, accompanied by difficult 
breathing, and followed by dizziness. 

Mercnrins. Chronic, moist cough, worse at night. 

Hy OSC yaiXlUS . Nervous, dry, spasmodic cough, worse at 
night, especially on lying down. 

Belladonna. Short, dry, hollow, convulsive cough, worse 
at night, with tickling in throat, flushed face, headache and 
cerebral congestion. 

Bryonia. Hard, dry, shaking cough, with pain in side, 
chest and head. 

GENERAL MEASURES. Is a symptom, and the cause 
must be ascertained and removed. In simple cough, a 
cold compress about throat at night often relieves. Drink 
small quantities of cold water at frequent intervals. Gum- 
water, and demulcent drinks, when from simple irritation. 

WHOOPING COUGH. 

SYNONYM: Pertussis. 

LEAUIXG REMEDIES. 

Aconite. Initiatory fever, -with dry, hard, wheezing 
cough, burning pains, or dry itching in larynx. 
" Indispensable for the fever." Bcenninr/liausen. 

Ipecac. Violent, suffocative cough, the child becoming 
stiff and blue in the face, gagging and vomiting of mucus. 
" One of our best remedies." Baehr. 

Drosera. Spasmodic stage, with frequent and exces- 
sively severe paroxysms of hoarse, loud cough, sometimes 
with bleeding from nose and mouth. Fever may be absent, 
or, fever intermixed with chills, accompanied by perspira- 
tion, and after the cough, vomiting of food or mucus. 
Dose: lx or tincture. Bayes. 

"Holds a prominent place among whooping-congh remedies." 
Bcenninghausen. 

Hydroey. acid. Spasmodic stage, convulsions and suf- 
focative attacks. 

•' Exerts almost magical influence." West. 



30 



KEY NOTES OF MEDICAL PRACTICE. 



Belladonna. Sudden, violent paroxysms of cough, with- 
out expectoration, worse at night, with sore -throat, cerebral 
congestion, redness of eyes, epistaxis. 

"Very useful remedy. Suitable only at the beginning, or, later, 
when there is cerebral congestion or fever." Bainninghausen. 

Carbolic acid. Second stage. Cough dry, hard, spas-' 
modic. 

I have used the 2x with excellent effect. 

Coralliutn rub. " A remedy of exceeding value in vio- 
lent cases." Carroll Dunham. 

Cuprum. Convulsions. "Has always succeeded with 
me." Jousset. 

Phosphorus. Supervening broncho-pneumonia. 

Hepar s. Croup prevailing at time of epidemic of 
whooping cough. 

GENERAL MEASURES. In case of infants, watch 
them closely, and take them up if paroxysm of cough sets 
in. Wear warm clothing, and guard against chill. If 
attack severe, give plenty of nourishing food, to keep up 
strength. 

BRONCHITIS. 

Aconite. Early in attack; chill and fever, dry, hot skin, 
restlessness and thirst, short hard tickling cough, with con- 
stant laryngeal irritation. To be of service Aconite must 
be given early ; later it is of no use except as intercurrent 
if there be continuous fever. 

"Should the inflammation have thoroughly established itself, wej 
cannot expect Aconite alone to cure it." Hurjhcs. 

Antimoniuin tart. Great oppression and suffocative 
breathing, extensive mucous rales, great rattling of mucus 
with the cough, but nothing is raised. Also, symptoms of 
incipient carbonic-acid poisoning — sopor, delirium, pallor, 
bloated countenance; also, profuse sweat without relief, 
disposition to vomiting and diarrhcea, paroxysms of rat- 
tling cough, ending in vomiting. For capillary bronchitis 
of children, and pneumonia notha of the aged. 

" Enjoys the largest sphere of action, and is pre-eminently character- 
ized by a profuse excretion of mucus which it is difficult to raise, with or 
without fever." Baehr. 

"The grand remedy for this dangerous disorder (suffocative catarrh 
of the aged). I have almost invariably relied upon it alone, and have 
seen desperate cases recover under its use." Hughes. 

Belladonna. Dry, distressing, spasmodic cough, in 
short paroxysms, but very violent, especially towards even- 
ing; no expectoration, or yellowish, tenacious, scanty, 
blood-streaked. Respiration oppressed, irregular and hur- 
ried. Sensation of fullness in chest, with determination of 
blood to lungs. Useful only in first three or four days. 

"Bronchitis setting in with violent fever; moderates the latter nnich 
more certainly than Aconite." Baehr. 



CHRONIC BRONCHITIS. 



31 



Mercnriiis. Violent fever, temperature high; great 
perspiration, without relief; alternation of chills and heat, 
with great sensitiveness to changes of temperature. 
Tongue with thick, yellowish coating; diarrhoea. Feeling 
of dryness, roughness, and soreness down middle of chest, 
violent, wearing cough, especially in evening and until 
midnight, with tenacious, yellowish, sometimes blood-tinged 
expectoration, every paroxysm of cough preceded by anxious 
oppression and dyspncea. Unquenchable longing for ice- 
cold drinks. Particularly adapted to children and robust 
adults — not so much for old people. Mucous membranes 
extensively involved — lungs, stomach, bowels. 

Bryonia. Trachea and large bronchi affected. Dry 
cough, with stitches in the chest, short, labored respiration. 
With cough, determination of blood to head, turgescence of 
face. Ordinary '* cold on the lungs." 

" Too extensive claims nre made for Bryonia. Good where the 
catarrh invades the trachea and large bronchi— it is of little use 
beyond." Hughes. 

Kali bi. Burning pain in trachea, cough with expecto- 
ration of tough mucus, which can be drawn out in strings; 
tongue thickly coated, with loathing of food. 

" Bronchorrhcea, -with copious, purulent expectoration, give Kali bi., 
by inhalation, two grains to four ounces of water." Meyhoffei: 

Ipec. Asthmatic breathing; much nausea and vomiting 
of mucus, rattling of mucus in bronchial tubes, face livid 
during cough. Loud mucus rales, with wheezing respira- 
tion. Severe gastric ailments and intestinal catarrh, pallid 
or bluish or bloated countenance. Principally adapted to 
bronchial catarrh of children. 

Hepar S. Cough, with wheezing over whole chest, in 
severe paroxyms, with danger of suffocation. Expectora- 
tion of a yellowish, tenacious mucus. Croupous bronchitis. 

Verat. alb. Failing strength, increased frequency and 
irregularity of pulse, coarse rales, secretion of copious 
quantities of mucus, which cannot be coughed up. Skin 
cold, with cold sweat. 

Arsenicum. For aged people, with great debility;, 
oedema of lunys. 

Phosphorus. Complications — oedema of lungs or pneu- 
monia. 

Rhus. Typhoid symptoms and violent fever. 

CHRONIC BRONCHITIS. 

With mucus expectoration. — Ant. tart., Kali bi. 
With purulent expectoration. — Merc, Sil., Lye, Calc 
Sulph., Iod. 

"No bronchial disease of long standing can be successfully treated 
without Sulphur or Lycopodium.*' Meyhoffer. 

Sulphur. Rheumatic or gouty subjects, or those of 



KEY NOTES OF MEDICAL PRACTICE. 



scrofulous diathesis. Bronchorrhoea, with putrid expecto- 
ration. 

"Curative in the most inveterate forms." Meyhoffer. 

GENERAL MEASURES. If patient suffering from 
extreme dyspnoea, hot fomentations to the chest afford 
prompt relief. Do not leave fomentation on to become 
cold — renew at frequent intervals. 

Diet. In acute, with fever, diet as in other fevers. 
When profuse expectoration, nourishing, albuminous food. 
Demulcent drinks good — milk, gruel, barley-water. 

ASTHMA. 

Arsenicum. Asthma with burning heat in chest, cold 
sweats, complicating heart disease, or following bronchitis. 
The more the patient seems on the point of suffocating, the 
more painful and distressing his restlessness, the more 
wheezing and louder their respiration, the more Arsenicum j 
will be found appropriate. This is accompanied by livid 
countenance, cold sweat, frequent, small pulse, palpitation, 
distended abdomen. 
"Arsenic sometimes exerts a magical effect.'' Baehr. 

Nux TOm. Tongue coated with thick, yellow fur. slight 
nausea, flatulence, constipation, disorders of digestion. 

"The best curative medicine we have for simple spasmodic asthma, 
where there is no bronchial lesion." Hughes. 

Ipecac. Attacks of suffocation, feeling of constriction 
in throat and chest, coldness, paleness, anxiety and sickness, 
rattling of mucus in bronchial tubes. Bronchitic asthma. 
Give frequent doses during paroxysm. 

Lobelia. Purely nervous asthma; constrictive, suffoca- 
tive sensation, vertigo, natlsea, vomiting, sense of great 
emptiness in stomach. 

Aconite. Dyspnoea, labored breathing, great fear and 
anxiety of mind, suffocative cough at night. Often relieves 
during paroxyfem of spasmodic asthma, and bronchitic 
asthma from cold.' 

Sambucus. Violent dyspnoea, nightly suffocative at-j 
tacks, with profuse perspiration. Especially useful in; 
asthma of children. 

Grintlelia. Mucus asthma, tenacious sputa, nervous and, 
cardiac asthma. 

Sulphur. Gouty subjects, or those subject to skin- 
diseases. 

GENERAL MEASURES. Let patient seek most com- 
fortable position for himself, to favor respiratory effort. 
Keep atmosphere of room moist. To relieve paroxysm:—^ 
A cup of very strong coffee; drop doses tincture /per; inha- 



PNEUMONITIS. 



33 



lation of Nitrite of Amy I, of Chloroform or Ether; inhala- 
tions of the smoke of burning Stramonium leaves, made 
up into cigarette, or in a pipe — twenty grains of the leaves, 
or ten grains of the dried root. Soak blotting-paper in a 
strong solution of Potass ic Nitrate (saltpetre), and dry it 
thoroughly. Burn this, and let the patient inhale the 
fumes. 

Diet. Important. Asthmatics are generally dyspeptic, 
and much can be accomplished by attention to stomach. 
Never overload stomach. Do not eat hearty meal late in 
the day.- Let the diet be nourishing, but plain, wholesome, 
and easy of digestion. Use no coffee. 

PNEUMONITIS. 
SYNONYM: Lung-fever. 

PROGNOSIS. Favorable: Acute; uncomplicated; pre- 
viously healthy subjects; one lung. Unfavorable: Ex- 
tremes of life ; complication with Blight's, heart, pregnancy, 
etc.; pulse over 150; delirium after first week; collateral 
oedema ; gangrene ; both lungs. 

CAUSES OF DEATH. Collateral cedema; heart-failure 
and heart-clot; asphyxia; asthenia. 

LEADIX<; REMEDIES. 

Aconite. Initiatory chill and fever. Stage of conges- 
tion. Of no use after hepatization, and Verat. v. is often 
superior to it in first stage. 

Veratrum vir. Stage of congestion; full, Hard, bounding 
-pulse, rusty expectoration, great oppression of chest; de- 
lirium. 

"I have seen the happiest effects when the attack came with a severe, 
long-lasting chill." J. P. Dake. 

Bryonia. Moderate fever; severe, shooting, cutting 
pains in chest; painful cough, with scanty expectoration of 
tough, rust-colored mucus. Stage of restlessness had 
passed, patient quiet and exhausted; tongue covered with 
thick, white fur, stomach inactive, liver engorged. Rheu- 
matic pains in chest muscles. 

" The most essential remedy in second stage." Baehr. 

Phosphorus. Stage of hepatization. Pain not very 
severe — vaguely localized stitches. Great weight and 
oppression of chest, marked embarrassment of respira- 
tion, cough, with bloody, muco-sanguinolent, or sanguino- 
purulent, difficult expectoration. Very useful in severe 
cases, asthenic pneumonia, and "typhoid pneumonia." 
Collateral cedema. 

' " Our sheet-anchor in pneumonia." Hirschel. 



34 



KEY NOTES OF MEDICAL PRACTICE. 



Antimonium tart. Commencing resolution. Increased 
frequency of pulse, great anxiety and restlessness, copious, 
cool perspiration, pallid countenance, suffocative spells, 
great dyspnoea, loose, rattling cough, as if much would be 
expectorated, but nothing comes. Impending paralysis of , 
lungs. Collateral oedema. 

" One of the most important remedies when pneumonia deviate? from 
its normal course." Baehr. 

Sulphur. After defervescence, to promote resolution; , 
tedious course. 

" A deficiency of reaction, and a simultaneous absence of such symp- 
toms as point to a destruction of the organic powers, constitute the ' 
best indications for this remedy." Baehr. 

SPECIAL. REMEDIES. 

Chel. Liver complication. 
Sang. Suppuration; hectic fever. 
Lye. Chronic pneumonia, with hectic. 
Ac. nit. In aged, or of feeble constitution. 
3Ierc. Broncho-pneumonia; profuse sweats. 
H>1>. s.. Sil. Purulent infiltration. Abscess, 
Bell. Cerebral congestion, delirium, convulsions. 
Rhus. Typhoid character; "prune-juice" sputum. 

GENERAL MEASURES. Keep patient in large, wed 
■ventilated room. Abundance of pure air important.* 
Patient should be propped up in bed, in a raised jwsture.] 
Large, thin poultice to chest. Give mucilaginous drinks, 
and nourishing food. 

CONGESTION OF THE LUNGS. 

Aconite. In plethoric subjects, with short, anxious 
breathing, pulse quick and hard, burning, pressing pains, 
in chest. 

" The main remedy." B~tehr. 

"All-sufficient when case taken early." Hughes. 

Yerat. vir. Great arterial excitement, faint feeling in : 
stomach, nausea, heart's beat loud and strong, pulse fall ' 
and hard. 

" Has often cured.*' Hempel. 

Cactus. Congestion of lungs dependent on cardiac affec- 
tion, with oppression of respiration, acute pains, feeble 
voice, feeling of constriction. 
I have used this remedy with excellent effect. 

Phosphorus. Feeling of great weight on chest. 

" When turgescence so great as to allow oedema to occur." Hi ghee. 

(EDEMA OF THE LUNGS. 
Phosphorus. Acute pulmonary oedema in connectior 



HAEMOPTYSIS. 



35 



with pneumonia, or other diseases of the respiratory or- 
gans. 

" This remedy sometimes has a brilliant effect." Kafka. 

"It is possessed of extraordinary powers against oedema." Baehr. 

Antimoniiim tart. Cyanosis, audible rattling, great 
dyspnoea, coarse rales, the bronchial tubes containing a 
great quantity of mucus, the patient in constant danger of 
suffocation. (Edema of lungs occurring in course of gen- 
eral dropsy, 

"I have more than once seen the cedeina subside entirely under the 
use of this medicine." Hughes. 

Arsenicum. Supervening on anasarca; great debility 
and prostration. 

Amnion, carl). Give on first signs of drowsiness, and 
carbonic-acid poisoning. 

HAEMOPTYSIS. 

DIFFEREXT1AL DIAGNOSIS. 

HAEMOPTYSIS. HEMATEMESIS. 
Blood - - Bright red - Dark. 
Blood - - Coughed up - Vomited. 
Blood - - Frothy - - Fluid. 
Mixed with - Sputum - - Food. 
Preceded by - Dyspnoea - Stomach distress. 
Stools contain No blood - - Blood. 
Respiration - Rales in lungs Lungs clear. 

LEADING REMEDIES. 

Aconite. Blood red, frothy: incessant cough, hot chest, 
anguish, red face. Dose: "Low dilutions, repeated very 
often." Jousset. 
"Indispensable in sthenic cases." Hughes. 

Hamamelis. Profuse haemorrhage of venous blood, 
coming into mouth without effort, like a warm current. 

"When blood is black, a precious remedy." Jousset. 

"When flow is passive, from venous haemorrhage, a reliable remedy." 
Hughes. 

Arnica. Abundant, blackish blood, with clots, after in- 
jury or bodily exertion. 
"Especially useful when with heart-disease or traumatism." Jousset. 

Ipec. Copious bleeding, precede J by sensation of bub- 
bling in chest. Cough, with spitting of blood, occasioned 
by least effort. With cough, tickling behind sternum. 
" Holds high rank." Hughes. 

Millefolium. Blood red, frothy, ejected without muoh 
coughing. 

"Almost always justifies the indications." Hughes. 
Yerat.vir. From congestion of lungs, with full, hard, 
bounding pulse. 



36 



KEY NOTE? OF MEDICAL PRACTICE. 



Cactus. Marked arterial excitement; haemorrhages, from 
over-action of the heart. 
"Haemoptysis with heart-disease." Raue. 

Digitalis. From obstruction of pulmonary circulation in 
consequence of heart-disease and tuberculosis. 

Phos. Tight feeling in chest, ivith dry, tight cough, fol- 
lowed by haemorrhage. 

"Inflammatory symptoms supervening on nu attack of haemoptysis." 
Hughes. 

"The principal remedy when haemoptysis with dangerous cases of 
fever." Joussnt. 

GENERAL MEASURES. Recumbent posture, head 
and shoulders elevated — airy room. Bits of ice in mouth. 



PLEUR1TIS. 

PROGNOSIS. Favorable: In young and healthy; effu- 
sion scanty; early absorption. Unfavorable: In cachectic; 
double-sided; persistent high fever; rapid increase of 
effusion, or return after having once subsided; complica- 
tion with phthisis. 

CA.USES OF DEATH. Collateral oedema of lungs; 
perforation of diaphragm, and peritonitis; perforation of 
lung, with pneumo-thorax; hectic; pneumonia; syncope 
from dislocation of heart. 



JLEADIN& REMEDIES. 

Aconite. Chill and initiatory fever. Great thirst, quick 
and rapid pulse, hot, dry skin, red face, shortness of breath, 
great nervous excitability, piercing, stitching pains in chest 
with dry cough. 
"In simple, acute pleurisy, the sufficient medicine." Hughes. 

Bryonia. Acute, stitching pains in side, greatly aggra- 
vated by breathing or movement; labored, short, anxious 
and rapid breathing, performed almost altogether by 
abdominal muscles. 

" The sovereign remedy when the inflammation has advanced to the 
stage of serous effusion." Trinks. 

Arsenicum. Great dyspnoea, with but little pain. Sec-' 
ond stage, patient much prostrated, weak and cachectic. 

" It will accomplish more than any other remedy in the stage of 
effusion." Mitchell. 

SPECIAL REMEDIES. 

Apis. Resorption of effusion. 
Ant. t.. Phos. Pleuro-pneumonia. 
Arn. From over-exertion or a blow. 



HYDROTHOKAX— PLEURODYNIA. 



37 



Iod. In scrofulous subjects, replaces Bry. 
Snlpll. Plastic exudation, slow to disappear. 
Merc. Exudation inclines to become purulent. 

GENERAL MEASURES. Absolute rest important. 
Poultices large, hot, and frequently renewed. Thoracentesis 
called for if amount of effusion great , great dyspnoea, and 
imminent danger from suffocation: effusion liable to re- 
turn if done before fever subsides. Use aspirator, needle 
anointed with oil — no preliminary incision; introduce near 
axilliary line, fifth intercostal space on left side, fourth on 
right, near upper edge of rib; patient recumbent; evacuate 
slowly; admit no air. 

Diet. As in fevers generally. Sustaining diet if much 
suppuration. 

EFFUSION IN PLEURAL CAVITY. 

Apis. Oppression very great, inability to lie down, ab- 
sence of thirst, dark and scanty urine. From recent 
inflammation, and after scarlet-fever. 

"Absence of thirst and suddenness of cedeina reliable indications." 
Hempel. 

Sulphur. " Unabsorbed pleuritic effusion, and that 
which comes on insidiously. I have frequently cured with 
the continued use of the tincture of Sulphur, three or four 
doses a day at first, but, as improvement continues, one or 
two doses a day." Dr. Cede. 

HYDROTHORAX. 

Arsenicum. Severe dyspneea. Suffocative attacks, 
especially at night. Patient cachectic, face bloated, small 
pulse. Idiopathic cases. 

Digitalis. Secondary to cardiac affection. Face pale 
Or bluish, pulse slow and intermittent, urine scanty. 
" Digital is the remedy in cardiac dropsy." Hale. 

Apocynnin. When amount of effusion very great. Main 
treatment to be directed to primary disease, on which the 
dropsy depends. 

PLEURODYNIA. 

Aconite. Rheumatic pleurodynia, recent attack, with 
fever. 

Bryonia. Sharp, stitching pains, with rheumatic ten- 
dency. 

Arnica. Myalgic pleurodynia, with stitching pains; 
" spurious pleurisy." Hughes. 



38 



KEY NOTES OF MEDICAL PEAOTICE. 



Actea rac. Neuralgic pleurodynia, with deranged uterine 
function. " Is specific." Hughes. 

Ranunculus. Idiopathic intercostal neuralgia in anaemic 
or debilitated subjects. 

Nux vom. Hsemorrhoidal subjects; patient cannot lie 
on affected side. Jousset. 



DISEASES OF CIRCULATORY SYSTEM. 

HE A KT. 

PERICARDITIS — ENDOCARDITIS — MYOCARDITIS. 

DIAGNOSIS. — Pericarditis. Friction-sound synchron- 
ous with heart-beat, until effusion, when there is increased 
area of cardiac dulness and displacement of apex-beat. 
Rarely idiopathic; generally occurs as complication of 
rheumatic fever, pleurisy, pneumonia, albuminuria or sep- 
ticaemia. 

Endocarditis. Systolic, ventricular, valvular murmur, 
of recent origin, associated with a condition which would be 
apt to excite this affection. Seldom idiopathic — generally 
associated with acute rheumatism. 

Myocarditis. No characteristic signs — always accom- 
panied by peri- or endo-carditis. 

CAUSE OF DEATH. Cardiac palsy— the pulse be- 
comes small and irregular, pulmonary veins engorged, and 
death from asphyxia consequent upon ondema of lungs. 

EiEADimre remedies. 

Aconite. Acute, stitching pain in praecordium; difficult 
breathing, with suffocative feeling; feeling of tightness 
about heart; intermission of beats, or tumultuous palpita* 
tion felt over large area, with irregular action and volume 
of pulse. Great anxiety and tossing about. 

Aconite finds its. true sphere in cardiac inflammation, whether or not 
there be high fever. Useful not only nt beginning, but sometimes 
throughout entire course of the disease. 

Spigelia. Severe shooting or stabbing pains, distressing 
oppression of chest, the least motion almost producing 
suffocation; violent palpitation, so severe that the walls of 
the chest are raised. 

An important remedy in rheumatic endocarditis Pain and violent 
action of heart highly characteristic. 

Digitalis. Pericarditis coming on insidiously; friction- 
sound of short duration; serous effusion, distressed breath- 



DISEASES OF THE CIRCULATORY SYSTEM. 



39 



ing, syncope, palpitation, intermittent, feeble pulse, not 
synchronous with heart-beats; livid, turgescent face, with 
blue lips. Hyperemia of liver; great anxiety, without any 
continual restlessness. 

" An excellent remedy in acute affections of heart, more particularly 
pericarditis. If more frequently used in acute heart-affections, would 
fee less frequently called upon to use it in chronic heart-disease." 
Baehr. 

Bryonia. Pericarditis as complication of rheumatism, 
pleurisy or pneumonia. Commencing effusion, sharp, 
stitching pains in pitecordium. 

"For idiopathic pericarditis, we have much better remedies." 
Baehr. 

Arsenicum. Pericardial effusion, violent palpitation, 
rapid pulse, intense thirst, burning pain, anxiety, faint - 
ness, extreme restlessness, suffocative attacks, coldness of 
surface, great anguish and apprehension of death. 

( actus. Sharp, pricking pain in heart, or sense of 
constriction; oppressed breathing, dry cough; pulse quick, 
throbbing, tense and hard. Great palpitation. 

Laehesis. Cramp-like pain, anxiety about the heart, 
suffocation on lying down, oppression on lying down, hands 
and feet cold, pulse intermittent. 

" A good remedy in endocarditis." Buelir. 

Verat. vie. Strong, loud beat of heart, with quick pulse- 
and difficult breathing. 

Verat. alb. Cold sweat. Hippocratic countenance, signs 
of collapse. 

Naja, Aconite. Iodine. After an attack of endocarditis, 
to complete a cure and prevent valvular disease. 

Valvular Disease. Arsenicum, Plumbum. 

Dilatation. Digitalis, Physostigma, Tabaeum. 

Cardiac Dropsy. Digitalis, Spigelia, Arsenicum. 

Fatty Degeneration. Phosphorus, Arsenicum, Arnica 
(to relieve dyspnoea in fatty heart). 

Hypertrophy. Aconite, Cactus, Naja, Spigelia, Arnica 
(after training, rowing, and violent muscular exercise). 

PALPITATION : 

Cactus. When due to plethora. 
Coff., Xux. Nervous palpitation. 
China. Due to excessive tea-drinking. 
Tabaeum. Palpitation with fainting attacks. 
Moschus. To be given at the time of an acute attack. 

GENERAL MEASURES. In acute inflammatory, rest, 
and hot poultices over region of heart. In chronic organic 
disease, avoid running, climbing, all over-exertion and 
mental excitement, and hearty meals. 



40 



KEY NOTES OF MEDICAL PRACTICE. 



ANGINA PECTORIS. 

LEASING REMEDIES. 

Arsenicum. Extreme dyspnoea, increased by slightest 
motion; debility, pale and haggard face, feeble and irregu- 
lar pulse, fear of immediate death. 

This remedy is chiefly useful given in the intervals of the 
attacks, as a curative, or preventive, if the case is one of 
pure neurosis. Dose: — Higher attenuations recommended. 

" No remedy can be more certainly relied upon than Arsenic.' l, Hart- 
mann. 

Spigelia. Severe stabbing stitches in heart at every 
beat; violent palpitation, tendency to syncope. Dose: — i 
Begin with third, give higher or lower according to sus- 1 
ceptibility of patient. 

" This is the principal medicine for angina pectoi is; it corresponds to j 
the anguishing, sub-sternal pain, radiating to the neck and arms, irreg- A 
ularity of pulse: tendency to syncope; palpitat ion; aggravation by the \ 
least movement." Jousset. 

Digitalis. Cases in an advanced stage, recurring fre- 
quently and suddenly. Dose: — Baehr recommends Digitalin, I 
2d and 3d triturations. 

Hydrocyanic acid. Violent palpitation, long fainting- 
spells, feeling of suffocation, with torturing pains in chest, 
irregular, feeble beating of heart. Recent cases. 

SPECIAL. REMEDIES. 

Glonoin. Pale face in paroxysm. 
Cuprum. Muscular, of long standing. 
Aeon. Recent cases, plethoric subjects. 
Cactus. Constrictive pain; rheumatism. 
Nux V. Gouty or hemorrhoidal subjects. 
Verat. alb. Cold extremities, cramps, cold sweat. 

GENERAL MEASURES. At the time of an attack, 
place patient in comfortable position, with plenty of fresh 
air; loosen clothing, apply large, hot fomentations over 
region of heart, and warmth to extremities. Give inhala- 
tions of Nitrite of Amyl. Put ten drops on a bit of cotton 
in a drachm vial — keep corked when not in use. Give fre- 
quent teaspoonful doses of brandy. 

Those who are subject to attacks of angina pectoris ] 
should observe a regular, quiet mode of life, avoiding all 
excitement or over-exertion, errors of diet, overloading the 
stomach, or anything which may e.rcite the heart's action. ' 
The use of tobacco must be strictly prohibited. 



DISEASES OF THE DIGESTIVE TRACT. 



41 



DISEASES OF THE DIGESTIVE TRACT. 
STOMATITIS. 

MerCUrillS. Swollen glands and abundant salivation. 

Hydrastis. Yellow-coated tongue, viscid secretions. 

Acid uit. When accompanied by derangement of liver 
and portal congestion. Also, when of mercurial origin. 

Kali chlor. Mercurial stomatitis. Breath fetid, with 
ulcers on mucous surfaces. 

GENERAL MEASURES. Use gargle of Kali chlor.. 
grs. viii. to § water. 

PAROTITIS. 
SYNONYM: Mumps. 

Aconite. Fever, hot. dry skin, furred tongue. 
Merc. iod. The gland swollen, red and painful; jaws 
stiff. 

Rhus. Swelling becomes dark-red and erysipelatous. 
Pulsatilla. Metastasis to breasts, or to testicles. 
Belladonna. Sudden disappearance of swelling, with 
loss of consciousness or delirium. 

GENERAL MEASURES. Keep child in warm room. 
In metastasis to mammie or testicles, use Belladonna oint- 
ment, one grain to the ounce. 

CANCRUM ORIS. 
SYNONYM: Noma. 

Arsenicum. Extensive disorganization, and great pros- 
tration. 
' ; Has do rival." Hughes. 

CONSULT — Merc., Lach. 

GENERAL MEASURES. Apply locally Subnitrate of 
Bismuth, sufficient to cover well the diseased parts. This 
has been used with great success. 

TONSILITIS. 
SYNONYM: Quinsy. 

Aconite. High fever, headache, restlessness; stinging, 
pricking fullness, or feeling of choking; throat looks as if 
scorched. 



12 



KEY NOTES OF MEDICAL PRACTICE. 



Belladonna. Bright redness and rawness of throat; 
flushed face, glistening eyes, headache, pain on swallowing. 

Merc. bin. Throat swollen; copious secretion of saliva, 
swelling of gums and tongue, fetid breath, ulcers in mouth, 
profuse perspiration and nightly exacerbation. 

Will often avert suppuration. 

Gelsemium. Initiatory fever; aching in all the limbs; 
great muscular weakness. 

Kali bi. Secretion of much viscid mucus. 
I have cured several cases of recurrent quinsy with Kali bt. and 

Gelsemium. 

Baryta carb. Sensation as of a plug in the throat; 
raw, scraping, or shooting pain on swallowing. 

" If you begin the treatment early with this remedy, suppuration 
need hardly ever occur." Hughes. 

Hepar s. Tonsils much swollen, with throbbing pain. 
This remedy should be given as soon as there are signs of 
commencing suppuration. 

Apis. Dryness of mouth and throat; much oedematoug 
swelling. 

Amra. mar. Putrid discharge and tendency to gangre- 
nous ulceration. 

Sil. Abscess slow to heal; scrofulous subjects. 
Each. Left side, with hyperesthesia of throat. 
Ars. Great prostration; throat putrid and gangrenous. 

GENERAL MEASURES. Early, bits of ice in mouth. 
Later, inhalations of steam give great relief. Lance as 
soon as pus has formed, with guarded bistoury. 



GASTRIC CATARRH — ACUTE AND SUB-ACUTE! 

Arsenicum. Burning distress in stomach, intense thirst, 
violent vomiting, with excessive pain, anguish and restless- 
ness, — vomiting immediately after drinking, great prostra- 
tion, quick, small pulse. Also in late stage, extremities 
cold, pulse small, features sunken, hiccough, extreme 
debility Dose: — Do not give too low — 6th to 12th. 
" The principal remedy— hardly any other needed." Hughes. 

Cantharis. Violent pains in stomach, the patient toss- 
ing about in agony. Severe burning in stomach, vomiting, 
with violent retching and burning thirst. Urine scanty, 
burning— constant desire, passing few drops at a time. 

Phosphorus. Vomiting of blood, mingled with bile or 
mucus; great fullness of stomach, with painfulness to pres- 
sure and cutting pains. Vomiting of water as soon as it 
becomes warm in the btomach. 

Mercurius. Pasty coating on tongue, extremely violent 
thirst, much saliva collects in mouth, bitter, sour vomiting. 



vjAijinn, uaxAKMH- (JHKUNIC. 



43 



Ii'is. Great burning and distress in epigastrium, vomit- 
ing, with great prostration, burning in mouth, fauces and 
oesophagus, headache. 
" Eminently adapted to many forms of mucous gastritis." Hughes. 
Aconite. Simple gastritis, from cold; distention, with 
burning, throbbing pains. Attack preceded by chill when 
muscular coat of stomach involved. Dose: — "Tincture." — 
Hempel. 

Verat. alb. Hippocratic countenance, eyes sunken and 
glazed, lips blue, extremities cold and covered with clammy 
sweat, almost imperceptible pulse. Intense thirst for cold 
drinks. 

Ant. cr. Great nausea, paroxysms of clawing, pressing 
pain, loathing of food, tormenting thirst, tongue with 
thick, white coating. 

"One of the chief remedies for gastric catarrh without fever." 
Baehr. 

Ipeo. Feeling of emptiness, with pinching pains and 
bloating, insipid, bitter, rancid taste, vomiting of ingesta, 
bile and mucus, and persistent nausea. Brought on by 
eating sour or fat food. 

Bryonia. Stomach bloated, exceedingly sensitive: nau- 
sea, with feeling of coldness and chills, and faintness on 
sitting up. 

Puis. Brought on by eating fats, fruits, ices or acid 
food; chilly creepings, sensation as of a mass of undigested 
food in stomach, greasy, rancid, bitter taste, tongue thickly 
coated, absence of thirst. 

NlIX V. After abuse of drugs, stimulants or condiments. 
Bitter or sour taste, sour belching, fullness and pressure 
in stomach, continued frontal headache, especially in 
morning. Not much pain. 

GASTRIC CATARRH — CHRONIC. 

REMEDIES : — Sulph., Lye, Nux v., China, Bismuth, 
Puis. 

Vomiting. Ipec, Kreas. 

Heartburn. Puis.. Caps. 

.Waterbrash. Lye, Nux v. 

Acidity. Calc. c, Phos., Sulph. ac. 

Flatulence. Carbo v., Lye, Arg. nitr. 

Gastralgia. Nux v., Bismuth, Cocc, Hydr. ac, Ars. 

GENERAL MEASURES. Acute. During height of 
attack, no food whatever. Give bits of ice to slake thirst. 
If attack protracted, and it become necessary to nourish 
patient, use nutrient enemata. As improvement progresses, 
feed cautiously. First, ice-cream, iced-milk with lime- 
water. Then, starchy foods only — arrow-root, rice, barley- 



KEY NOTES OF MEDICAL PRACTICE. 



water, gruels. Later, broths. No solid food until recovery 
is complete. Chronic. Care in diet, as in dyspepsia. Avoid 
tea and coffee, puddings, sauces, stimulants, fresh bread. 
Eat sloivly and masticate thoroughly. Butter-milk is excel- 
lent. A milk diet often curative. 

Wear warm clothing, and take salt-water sponge-baths to 
excite activity of skin. 

Drinking water as hot as can be taken, often relieves dis- 
tress, and stops nausea and vomiting. 

GASTRIC ULCER. 

DANGERS. Perforation of wall of stomach. Hemor- 
rhage from rupture of vessel. 

LEADING REMEDIES. 

Arsenicum. Constant thirst. Distention, pressure or 
cutting in epigastrium. Nausea, fainting, waterbrash, I 
vomiting thick, glairy mucus, or a brownish, blackish fluid, 
Burning in stomach, with great pain on pressure. 

" When ulcer at pyloric end." Hughes. 

" Deserves to be classed in foremost rank." Baehr. 

Argentum nit. Violent gnawing, griping and burning; 
painful swelling of stomach, with violent belchings. 

Kreasote. Vomiting, with heat and burning in stomach 
and bowels ; foul and sanious matter vomited, indicative of 
disorganization of mucous membrane. 

Cantharis. Severe burning pains in stomach, burning 
thirst, vomiting, with violent retching. 

Kali Yellow-coated tongue, nausea, foul taste and 
faintness. Giddiness, followed by violent vomiting of a 
white, mucous, acid fluid, with pressure and burning in 
stomach. Vomiting of sour, undigested food, of glairy 
fluid, of blood. 

" Ulceration near cardiac end." Hughes. 

Hydrastis. Sour eructations; dull aching, causing a 
weak, faint, gone feeling; cutting pains, with oppression 
and sense of weight; acute, distressing pain, with nausea, 
acidity and loss of appetite. 

SPECIAL K EM ED I ES. 

Atropine. " No medicine better to subdue the frightful 
cardialgic pain of ulcer of the stomach." Baehr. 

[pec., Ham., K rests. For haemorrhage. 

Opium. Perforation. "The only favorable recorded 
terminations to this event are those in which the opiate 
treatment was pursued." Dr. Wilson Fox. 



HiEMATEMESIS. 



4.-. 



GENERAL MEASURES. Complete cure possible in 
all recent cases. During severity of disease, absolute rest, 
confinement to bed, maintain warmth of body. 

Diet. In severe cases, give stomach absolute rest— nourish 
by nutrient enemata — beef-tea and milk, or nutrient sup- 
positories. This treatment continued thirty days will citre 
the most obstinate case. Return to solid diet gradually — 
milk only at first — then broths and gruels, and soft food. 
No sugar allowed. 

In other cases, milk-diet will accomplish desired result. 
Add lime-water, and a little boiled arrow-root to the milk. 
During the course of treatment let patient drink occasion- 
ally a tea-cup of weak dilution of Calendula. 

Perforation. Usually follows a hearty meal. Order 
absolute repose. Give Opium, to prevent movements of 
stomach. Continue opium treatment many days. 

Hannorrha'ie. Rest, ice, and the indicated medicine. 



HJEMATEMESIS. 

DIFFEREXTIAL l>IA«XOSIS. 



HaSMATEMESIS. 



HEMOPTYSIS. 



Blood - - Dark - - Bright red. 
Blood - - Vomited - - Coughed up. 

Blood - - Fluid - - Frothy. 

Blood mixed with Food - - Sputum. 
Preceded by - Nausea - Chest-pain. 

Preceded by - Stomach distress Dyspnoea. 
Stools contain Blood - - No blood. 
Respiration - Clear - - Rales in lungs. 

Tpec. Sudden attack, with great paleness of face and 
nausea. Vomiting of blood, or pitch-like substance. Inde- 
scribable sick feeling in stomach. Pulse scarcely percepti- 
ble. Fainting. 

" Has long-established reputation and deserves the preference." 
Hughes. , 

" There is no more efficacious remedy." Baehr. 

Hamamelis. Thin, dark blood. Fullness and gurgling 
in abdomen. Blood in vomit and stools. 

"A number of excellent cures have been reported." lle.mpel. 

Arnica. From mechanical injury or over-exertion. 
Vomiting of dark coagula. Soreness as if from bruise. 

Aconite. Excruciating pains in stomach, gagging, retch- 
ing, gasping for breath; distressed face, anguish, cold 
sweat on forehead. With great vascular excitement, pulse 
full, bounding and rapid. 

Arsenicum. Extreme palpitation, anguish, violent 
thirst, small, quick pulse, chilliness. 

Belladonna. Congestion of head and stomach, singing 



46 



KEY NOTES OF MEDICAL PRACTICE. 



in ears, nickering before eyes, red cheeks, feeling of fullness 
and warmth in stomach. 

China. For secondary symptoms, after all bleeding has 
ceased. 

GENERAL MEASURES. Command absolute rest in 
horizontal position; loosen clothing, and keep patient quiet 
and free from excitement. Room cool and airy. Let 
patient swallow small bits of ice, or, in its absence, take 
frequent sips of cold water. Gold applications over stom- 
ach harmful; mustard-plaster better. Following the at- 
tack, keep stomach at rest, nourish by enemata. The first 
food must be cool, and liquid. No solid food until every 
trace of pulsation in epigastrium has ceased. Fainting 
need not alarm — bleeding stops, if patient faint. Give 
medicine at frequent intervals. 



SICK-HEADACHE. 

SYNONYM: Gastric Headache; Bilious Headache. 

Iris. Sick-headache, beginning with blur before the 
eyes, followed by nausea and vomiting. Dull, heavy, 
frontal headache, with continuous nausea, and vomiting of 
mucus and bile. 

In "sick-headache" this is a most reliable remedy. Give the 
mother-tincture, ten drops in a half-glass of water, a teaspoonful at 
frequent intervals — every ten minutes. Your patient should experience 
relief in twenty or thirty minutes. 

Ipeo. Headache as if brain and skull were bruised, even 
to root of tongue. Intense and constant nausea. 

Nuv V. Sick-headache brought on by wine, coffee, close 
mental application, sedentary habits; begins in morning, 
increases through the day, with dimness of vision, sour, 
bitter vomiting, constipation, worse from noise, light, after 
eating. 

• Podoph. Bilious headache, beginning with blur before the 
eyes, darting pains in forehead, or, stunning headache 
through temples, giddiness, flushed face, heartburn, nausea, 
bilious vomiting, and diarrhoea. 

Chelidoiiiuin. In bilious temperaments, darting, tearing, 
throbbing pains in forehead and temples, with heaviness 
and coldness in occiput, accompanied by vertigo, anxiety, 
melancholia, nausea, and bilious vomiting. 

" When clearly of hepatic origin." Hughes. 

Bryonia. Head aches as if it would split, made worse by 
stooping or motion. Gets sick and faiut on sitting up. 
JSour, bitter vomiting. 

Verat. alb. Severe bilious vomiting, distressing head- 
ache, faiutness from violence of attack. 



HEADACHES OF FEMALES. 



4:7 



Hep. s. " A valuable remedy in chronic cases." Laurie. 
Naja. Temporo-frontal; dull pain. 
" A very valuable remedy." Holcombe. 

HEADACHES OF FEMALES. 

Sepia. Disorders of sexual function; irregular, scanty 
menses, leucorrhoea. dark rings under eyes. 

Platina. Plethoric, animated and sensitive subjects; 
dark hair, rigid fibre; menses profuse, accompanied by 
colicky pains. 

Ignatia. Hysterical subjects, with disposition to con- 
vulsions. Headache periodical — passes off with flow of pale, 
limpid urine. Feeling as if nail were being driven into 
head. 

Cocculns. Reflex uterine headache. Menstrual colic, dull 
headache, with vertigo and nausea. 

Aetea. Hysterical and menstrual headache; pain extends 
to eye-balls, attended by f aintness, and " sinking" at pit of 
stomach. 

DIAERH(EA— ACUTE. 

LEADIXft REMEDIES. 

Aconite. After checked perspiration, after cold or damp. 
Frequent, scanty, loose, green stools, with tenesmus, fever, 
and restlessness. 

Aloes. Pain and rumbling in the bowels before stool. 
Escape of great quantities of flatus with stool. Constant 
urging to stool. Stool involuntary, with escape of flatus — 
stool seems to pass without exertion — after stool sensation 
as if more in rectum. 

Antimoninm. Stools watery and profuse, with disor- 
dered stomach and white-coated tongue. Alternate constipa- 
tion and diarrhoea. 

" The gastric symptoms predominate." Bell. 

Arsenicum. Watery, mucous, or bloody discharge. Great 
weakness, faintness and rapid exhaustion, thirst and rest- 
lessness. Burning in rectum, emaciation, pallor, sunken, 
cheeks. Stools watery, fetid, painless. 

Apis mel. Stools greenish, yellowish, slimy mucus, or 
yellow watery. Tongue dry and slimy, little or no thirst. 
Hands blue and cold. 

" The absence of thirst, existing with a dry tongue, and dry. hot skin, 
are characteristic." Bell. 

Bryonia. Diarrhea in hot weather, stools brown, thin, 
fecal, or containing undigested matter. Aggravation in 
morning as soon as he moves. 

Calc. carh. Scrofulous subjects. Distended abdomen, 
with emaciation, whitish or watery stools. Chronic diar- 
rhoea, with chalk-like stools. 

" The stools are of less importance than the person." Bell. 



48 



KEY NOTES OF MEDICAL PRACTICE. 



China. Frequent, watery stools, containing undigested 
matter, with pinching colic, occurring especially at night. , 

Croton. Yellow, watery, or greenish-yellow stools, | 
expelled with great force. 

"The three highly characteristic symptoms of yellow, watery stool, 
sudden expulsion and aggravation from food and drink, form a trio . «J 
■whose presence will make success certain and brilliant." Bell. 

Dulcamara. Stools yellowish, greenish, watery, with 
colic. From " taking cold " in cold, damp weather. 

Cumin, gutt. Yellow or green stools, mixed with mucus. 
preceded by excessive cutting about umbilicus. 

" One of the most important remedies in the treatment of diarrhoea, 
acute and chronic." Bell. 

lpeo. Stools as if fermented, green, with nausea and 
colic. Frequent stools of greenish mucus. 

"The continuous nausea is the most constant distinctive symptom of 
Ipec." Bell. 

Iris. Bilious stools and bilious vomiting, in hot weather, 
with much exhaustion and debility. 

Merc. Stools slimy, brownish, whitish-gray, acrid and 
burning. Cutting, pinching pain in abdomen, with chilli- 
ness. Bilious stool, preceded by colic, followed by tenesmus. 

Phos. ac. Diarrhoea not debilitating, though of long 
continuance. Involuntary, with emission of flatus. 
Stool thin, whitish -gray. 

" One of the most prominent remedies for white, watery diarrhoea, 
acute or chronic." Bell. 

Podoph. Early morning diarrhoea, stool frequent, 
painless, yellow liquid, with meal-like sediment. 

Sulphur. Diarrhoea some hours after midnight, or 
driving patient out of bed early in the morning. Stools 
pappy, greenish-yellow, fetid, slimy. 

" Very wide range of action. Early morning diarrhoea very charac- 
teristic." Bell. 

Verat. alb. Diarrhoea, violent, painful, copious, with 
profuse perspiration. Stools watery, sudden, involuntary. 

" A remedy of great value and very often required. It is useless in 
painless cases." Bell. 

CHRONIC DIARRHOEA. Ars., cm,: China, Fern, 
Gum. (j., Hep. s., Lyc., Phos., Phos. ac, Podo., Sulph. 

GENERAL MEASURES. Those who are subject to 
diarrhoea should wear flannel bandage about abdomen, 
wear warm clothing, avoid exposure to wet and cold, keep 
feet dry. Look to drainage and see that there is no sewer-gas 
in dwelling. During acute attacks, absolute rest in bed. 

Diet. In acute attack, the less food the better. Avoid the 
use of solid food, liquors, coffee, strong tea, fruits or vege- 
tables. No potatoes. Let diet consist of milk and lime- 
water, broths, gruel, rice (well-cooked), barley-water, whey, 
panada, beef-tea, with teaspoonful isinglass to the half- 
pint. In chronic, nourishing, but simple and easily- 



DYSENTERY. 



49 



digested food — fresh meat, mutton, beef, soft eggs. Milk- 
diet good. Avoid salt and cured meat, pork, veal, and fresh 
vegetables. 

DYSENTERY. 

LEADING REMEDIES. 

Merc. COIT. Distressing, persistent tenesmus, and cut- 
ting, colicky pains. After stool burning and tenesmus of 
rectum and bladder. Urine scanty, hot. bloody, or sup- 
pressed. Stools — frequent, mucus mixed with blood, or 
almost pure blood. 

May safely be regarded as specific remedy for whole process." 
Baehr. " Applicable when occurring in great intensity, and accompa- 
nied by the characteristic urinary symptoms." Bell. 

Aconite. Early in attack, with fever, dry heat, great 
restlessness. Stool, — blood}', slimy, scanty, frequent, with 
tenesmus. Dose: — "The lower attenuations are to be pre- 
ferred." Hempel. 
" In very beginning often able to cut short dysentery." Bell. 

Belladonna. Violent fever, retention of urine, severe 
gastric derangement, nausea and vomiting. Violent urging, 
scanty discharge of slimy, bloody stool, with tenesmus; 
abdomen distended, hot and painful; spasmodic, clutching 
pains. 

" Often the only remedy required for severe cases of infantile dysen- 
tery." Bell. " Next to Mercuries the most important remedy in 
dysentery." Baehr. 

Aloes. Loud gurgling in abdomen. Before stool, sen- 
sation of fullness and weight in pelvis; after stool, fa intness. 
Stool, — bloody, jelly-like mucus. Tenesmus very severe. 

" One of our most valuable remedies in dysentery." Bell. 

Cantharis. Stool of blood and mucus, like scrapings 
from intestines. With stool, cutting in abdomen; after 
stool, shiverings. Scanty urine and tenesmus of bladder. 

" Appearance like scrapings of the intestines is the most character- 
istic symptom of Cantharis.''' Bell. 

Capsicum. Stools of mucus, streaked with black blood. 
Cutting colic, tenesmus, drawing pains in back. Drinking 
causes shuddering. Tenesmus of bladder, strangury. 

"One of the royal remedies for dysentery-" Sell. 

Arsenicum. Stools dark, bloody, acrid and excoriating, 
with tenesmus and burning in anus and rectum, and great 
prostration. Called for when case is far advanced, dis- 
charges dark and fetid, prostration extreme. 

SPECIAL REMEDIES. 

Coloc. Very severe colicky pains. 
Dnlc. Autumnal, from cold and wet. 
China. Intermits; returns periodically. 



KEY NOTES OF MEDICAL PRACTICE. 



Colch. Jelly-like, skinny stools; autumnal. 
Podo. Prolapse of bowel with every stool. 
Slllpll. After violence of attack has passed. 
Rhus. Low fever, involuntary, thin, at night. 
Arn. Tormina, tenesmus, much haemorrhage, 
[pec. Much nausea and vomiting; bloody stools. 

CHRONIC 1 DYSENTER Y. Nitr. ac, Phos. etc., Sulph., 
China, Cale.-earb, 

GENERAL MEASURES. Absolute rest in bed. Keep 
disinfectants, sulphate-of-iron and carbolic acid, in bed- 
pan. Dispose of discharges with antiseptic precautions. 
Preserve free ventilation. Change sheets and clothing daily. 
If distressing tenesmus, enema consisting of two ounces 
boiled starch containing thirty drops Laudanum, or five 
grains chloral-hydrate. Suppository containing one-half 
grain alcoholic extract Belladonna, also excellent. Hot 
fomentations to abdomen often relieve pain. Free injec- 
tions of hot water will relieve the distress accompanying a 
severe attack of dysentery, and help cut short the disease. 
Chronic. — Keep abdomen warm by flannel binder. Avoid 
cold and wet. Warm clothing. Remove from malarial 
district. 

Diet. Cold drinks often aggravate the colic. Simple 
diet — scraped meat, milk, gruel, barley-water, rice-flour 
gruel. Avoid solid foods, fruits, vegetables, and stimulants. 

PERITONITIS. 

ACUTE IDIOPATHIC. 

Aconite. From cold, with predominance of febrile 
symptoms. Burning, cutting, darting pain in bowels. 

" Indispensable." Hughes. " The principal remedy." Jousset. 

Belladonna. Severe congestions of head and chest; with 
anguish, dyspnoea, restlessness, dark-red and bloated face; 
continual distressing vomiting of bile, alternating with 
retching. Intestines distended, so that convolutions can be 
felt. Also, for the vomiting, in later stages. 

" Suitable only at the commencement." Baehr. 

Bryonia. Stage of exudation; stitching, lancinating 
pains in bowels, worse from slightest motion; tongue white 
and dry; great thirst; bowels constipated. 

" When primary fever relaxes, and effusion threatens." Hughes. 

MercurillS corr. Frequently exacerbating fever, with 
creeping chills, and copious perspiration after the heat. 
Peritonitis secondary to wounds and operations on abdo- 
men. Tendency to purulent effusion. Abscesses. 

'" Has high curative power." Hughes. 



PERITONITIS— COLIC. 



51 



Veratrnm alb. Copious and frequent vomiting, face 
pale and sunken, skin cold, pulse small; anguish, restless- 
ness and distressing thirst. 

Colocynth. Diarrhoea, with rectal and vescical tenesmus, 
with or without colicky pains. 

" Circumscribed peritonitis, from extension from abdominal organs." 
Jousset. 

Opium. Great distention of abdomen; retention of 
stool and urine; complete inactivity of bowels; paralytic 
weakness of intestinal canal, remaining after disappear- 
ance of the exudation. 

Arsenicum. Sudden sinking of strength; cold, clammy 
perspiration; restlessness, thirst, constant vomiting; burn- 
ing in abdomen. Also, later, when copious and persistent 
exudation. 

Sulphur. To excite and promote absorption of the ex- 
udation. 

GENERAL MEASURES. Warm fomentations; or, in 
some cases, cold compresses do more good than hot. Keep 
patient at perfect rest, and avoid all mental or emotional 
excitement. Keep room well ventilated and at even tem- 
perature. Sometimes necessary to remove even weight of 
bed-clothes from abdomen, by barrel hoops, or suitable 
contrivance. Turpentine stupes over abdomen. 

Diet. For intense thirst of early stage, give bits of ice. 
Ice swallowed sometimes relieves vomiting. As appetite re- 
turns, give food which will leave but little fecal residue. If 
much exhaustion, broths and nourishing food. Return to 
diet of solid food, very gradually and cautiously. 

COLIC. 

Coloc. Extremely severe, cutting, griping, intermittent, 
abdominal cramps, causing patient to bend double, with 
much moaning and complaining. 

Chamomilla. Flatulent colic, the abdomen much dis- 
tended. Flatulence passes in small quantities, without 
much relief. Pinching, twisting pain. Great impatience. 
Children want to be carried. 

Nux VOm. Flatulent colic from indigestion. Cramps 
in stomach, with upward pressure. Cutting, pinching pains. 
Frequent urgings to stool without effect. 

Iris Vets. Severe flatulent colic, with sickness of stom- 
ach, and headache. This remedy will often help when others 
fail. 

Plunil). Violent, constrictive, pinching painm region of 
navel. Retraction and hardness of abdomen. Flatulence 
and obstinate constipation. Face and skin pale, bluish or 
yellow. Chronic enteralgia. 



52 



KEX JNOTES OF MEDICAL PRACTICE. 



Opium. Great accumulation of gas in intestines, with 
great distention of abdomen, and cutting, preseive and 1 
twisting pains. Complete inactivity of intestines. 

DioSCOrea. Sudden attacks, with vomiting of food. Pain 
changes from one part of abdomen to another, with much I 
rumbling. 

COLIC:— 

Indigestion. Nux v.. Puis., Tpec, Ars. 
Infants. Cham., Bell., Gina, Tpec, Iris. 
Bilious. Merc, Ipec, Podoph., Dios., Iris. 
Flatulent. Nux v., chum.. Lye, Dros., Iris. 
Nervous. Coloc, Bell., Ign., Opium, Plumbum, 
Rheumatic. Verat. alb., Dulc, Bry., Puis., Rhus. 

GENERAL MEASURES. If stomach contain a mass 
of indigestible food, give warm water and salt, tickle back 
of throat, and produce emesis. Drinking large quantity of i 
warm water often relieves. Place patient on left side, with i 
hips raised, and give copious injection of warm water, j 
Retain as long as possible. Apply hot fomentations to I 
abdomen. 

LEAD-COLIC. 

REMEDIES: — Opium, Platina, Alumina. Belladonna, 
Arsenicum, Stramonium. 

Opium. Retraction of abdominal muscles, slow pulse, 
obstinate constipation. 

" A most valuable specific." Baehr. " Soon gives relief." Hughes. 

AFTER-EFFECTS. Steam. Paralysis. Bell. Am- 
aurosis. 

GENERAL MEASURES. In acute attack, give free 
milk-diet, and let patient drink large quantities of soft I 
water. Use copious warm injections. Warm baths. 

Workers in lead should bathe and wash carefully, and 
change linen frequently. Do not eat in workshop. Keep 
up free ventilation. After one attack change of occupa- 
tion only will exempt from repetition. 

CONSTIPATION. 

Sulphur. Hard, knotty stools, accompanied by hamior- 
hoids, followed by burning pain in anus and rectum. Flushes 
of heat, frequent weak, faint spells. Good with which to 
begin treatment. The improvement begun under Sulph. 
must be followed by some other remedy. 

Nux vom. For those of sedentary habit, high livers, and 
after abuse of drugs. Frequent, ineffectual urging to stool, 
which is large, hard, and passed with great difficulty. Dys- 
pepsia and haemorrhoids. Often acts well after Sulphur. 



-k. 



53 



Opium. Complete torpor of bowels. Stools hard and 
lumpy. Headache, drowsiness, dizziness, congested face. 
Abdomen much distended, with almost complete paresis of 
intestines. 

Plumbum. Stools of small, hard balls. Frequent 
attacks of violent colic. Retraction of abdomen. Sense of 
constriction of sphincter ani. 

" The chief indication for the use of Plumbum in constipation is the 
constant presence of a spasmodic or colic-like pain." A C. Pope. 

Hydrastis. Headache and hemorrhoids. Severe pain 
in rectum after stool for hours. Especially useful after 
abuse of purgative medicines. Dose: — Drop of mother- 
tincture, once daily, before breakfast, for a week. 

"Has been curative of constipation more frequently than any other 
remedy." Hughes. 

Platina. Difficult expulsion of soft stool. Frequent 
urging, great straining, passing but small quantities; putty- 
like stool, sticking to the anus. Constipation while trav- 
eling. 

.Esoulus. Dryness of rectum, feeling as if full of small 
sticks. Painful haemorrhoids, with severe backache. 

LyCOpodium. Stools hard, scant, and passed with great 
difficulty. Ineffectual urging. Acidity and heartburn, 
loud rumbling and gurgling in bowels. 

Graphite&i Stools large, hard and knotty. Tendency 
to cutaneous disorders. 

Nitric acid. Stools hard, dry and scant, and passed 
without pain. Headache; sour or bitter taste after eating; 
sour eructations, excessive flatulence. 

"In the front rank of remedies for constipation." Dyce Brown. 

Ignatia. Constipation with prolapsus of rectum on 
slight effort to evacuate; creeping, itching sensation in 
abdomen. 

Bryonia. Hard, large, dry stools; chilliness; pain about 
the liver; rheumatic tendency, accompanied by symptoms 
of indigestion; frequent eructations after meals; headache. 

GENERAL MEASURES. Drink a goblet of oatmeal- 
water every morning on rising. Avoid tea and coffee. Let 
the diet consist largely of coarse meals, succulent vegeta- 
bles and juicy fruits. Eat brown bread rather than white. 

Diet. Avoid: — Tea. coffee, wine, beer, pork, veal, salt- 
meats, cheese, beans, cakes, pastry, pickles, biscuit, fresh 
bread, muffins, griddle-cakes. 

Eat: — Mush, hominy, oatmeal, wheaten-grits, corn-bread, 
greens, cresses, squash, turnips, spinach, cabbage, tomatoes, 
asparagus, cauliflower, figs, pears, prunes, peaches, apples, 
oranges, melons, grapes, cherries, berries. 



54 



KEY 



HEMORRHOIDS. 

LEADING REMEDIES. 

vEscnliis hip. Haemorrhoids like ground-nuts, of a pur- 
ple color, very painful, with burning sensation. Itching, 
burning pains, with sensation of fullness and dryness of 
rectum. Slight haemorrhage. Severe aching pa ins in back. 
Constant and severe backache, extending to sacrum and 
hips. Stool hard and dry, passed with difficulty, followed 
by sensations of constriction, fullness, dryness, and prick- 
ing pains in rectum. 

Almost specific." Hughes. 

Hamamelis. Profusely bleeding hcemorrJwids. Burning, 
itching and rawness of anus. Weakness of back — feels as 
if it would break. Discharge of large quantities of dark 
blood. 

" Never fails in true varicosis." Huylies. 

" In excessive haemorrhage a certain remedy." Jousset. 

Aloe*. Haemorrhoids, with flow of hot, blackish blood. 
Haemorrhoids protrude, like bunch of grapes, with constant 
bearing down in rectum. Great heat and tenderness of the 
tumors, relieved by cold water. Heat in bowels, and heat 
and painful pressure in liver. Painful inflammation of the 
tumors. 

Collinsonia. Blind or bleeding piles, with sticking 
pains in rectum. Obstinate and habitual constipation, 
stools lumpy and light-colored. Uterine disorders. Con- 
gestive inertia of lower bowel. 

"In constipation and haemorrhoids I prefer it to Aloes." Hughes. 

Nux VOID. For blind or bleeding piles. From abuse of 
spirituous liquors, or sedentary habits. Bleeding, burning, 
and frequent protrusion of the piles. Abdominal plethora. 
Tearing, pressing, bruised pain in small of back. Habitual 
constipation. 

Sulphur. Bleeding, burning, and frequent protrusion 
of the piles. Stinging, burning and soreness, in and about 
anus. Itching /and tenesmus after a soft or bloody stool. 
Alternate constipation and discharge of blood-streaked 
mucus. 

SPECIAL REMEDIES. 

Caps. Burning and itching. 

Ferr. Cachectic constitutions. 

Aeon. Inflammation of tumors. 

Hep. s. Chronic hepatic affection. 

Pod. Portal congestion, bilious subjects. 

Ars. Emaciated subjects. Burning pain. 

GENERAL MEASURES. Avoid soft cushions, and 
feather-beds. Sedentary habits bad. Correct uterine disor- 



V 



ENTOZOA. 



55 



ders. Make a habit of going to stool shortly before bedtime. 
Injections of cold water beneficial. If piles inflamed and 
tender, anoint with Aconite cerate, and sit over steam of 
hot water. 

Ointment of Boracic acid and Vaseline has magic effect 
in relieving itching piles. 

Make cerate, or suppository, containing mother-tincture 
of JEsc, Ham., Aloes, Collin., or other indicated remedy, 
and use locally. 

Diet. Avoid coffee, peppers, spices, stimulating or 
highly-seasoned food, beer, wine, spirits, and do not over- 
eat. During attack, no meats. Vegetables and fruits best. 



ENTOZOA. 



T/ENTA SOLIUM. 

(TAPE-WORM. | 

Pepo semen. Take one ounce of pumpkin seed, the 
shells having been removed, mash it up and make an emul- 
sion with milk. Take this dose at bedtime, after having 
fasted from breakfast. In the morning take a tablespoon- 
ful of castor-oil, abstaining from breakfast. Use one-half 
this dose for children under twelve. 

Filix mas. I? . 01. Filic. maris 3j. 
Mucilag. 

Glycer. aa 3ij. 
Aqua. dest. §j. Mix. 

Dosk: — Give in four doses, fasting, and follow by castor- 
oil. 

Or, give drop doses Male Fern, every four hours, and a 
dose of Merc. corr. night and morning. Continue several 
days. 

Punica granatum. Take of Pomegranate root (Granat. 
rad. cort.) two ounces, put into one quart of water, macerate, 
and boil down to one-half the quantity. Dose:— two fluid- 
ounces every half hour, after having fasted. 

Rottlera tinctoria. Give two or three teaspoonfuls of 
tincture, after twelve hours' fasting. A dose of Castor oil 
may be given if no purgative action follow the taking of 
the medicine. 

" This is the pleasantest, safest and surest remedy with which I am 
acquainted. " Lewis Sherman. 



KEY NOTES OF MEDICAL PRACTICE. 



A.SCARIS LUMBRICOIDES. 
(ROUND-WORM.) 

Santonine. Give two-grain doses of 2x trit. every three 
hours. This is a genuine specific for the round worm. For 
young children use Cina. 

The symptoms indicating the presence of worms, and 
calling for this remedy, are— Boring at the nose, livid cir- 
cles about the eyes, slight fever, f retfulness and ill-temper, 
short, hacking cough, coated tongue, bad breath, tossing 
and uneasiness, or crying out in sleep, nausea and vomiting, 
capricious appetite, itching of nose and anus, the urine 
white and thick; sometimes convulsions. 

Merc, corr., Ant. crud., Stannum. The existence of 
worms is usually accompanied by an unhealthy state of the 
mucous membranes of the intestines, which secrete a large 
quantity of tenacious, slimy mucus. To correct this con- 
dition Mere, corr., Ant. crud. or Stannum, the principal 
remedies, must be given, when the worm-symptoms will all 
disappear. 

OXYURIS VERMICULARIS. 

(PIN-WORMS.) 

Teucrium. Thread-worms, with much itching- and irrita- 
ticttion about the anus, especially troublesome in the evening; 
deddepraved or capricious appetite, pains in the epigastrium, 
pi j picking at the nose, offensive breath, straining at stool, dis- 
tutturbed sleep and general restlessness. 

Lard should be applied locally — it relieves the irritation, 
deddestroys the worms and stops their breeding. 



DISEASES OF THE LIVER. 

CONGESTION OF THE LIVER. 

Podophyllin. Feeling of fullness in right side, with 
accacute pain in one spot. Active congestion, with pronounced 
bi I bilious symptoms. Diarrhoea, prolapsus ani, bitter taste, 
sag sallow complexion. 
' "When 'bilious' symptoms predominate, best remeclyi" Hughes. 

Leptandrin. Aching pains in liver, yellow-coated 
to t tongue, prof use, papescent, tar-like, very fetid stools, con- 
st e stant dull pain in region of gall-bladder. Much soreness in 
h« 1 head and eyeballs. 



HEPATITIS. 



57 



Iris. Pain over liver, crampy pain in back, flatulence in 
bowels, griping pains, headache, vomiting, lassitude, pros- 
tration. Excites the biliary secretion. 
" A specific remedy." Hughes. 

Sulphur. Chronic cases, hepatic cases from portal en- 
gorgement. Constipation, or. early morning diarrhea. 
Frequent weak faint spells, with flashes of heat. 
' "A remedy of great value." Hughes. 
"In chronic, holds the first rank." Baehr. 

Sepia. Replace.s Sulphur in women at climacteric. 

Chelidonium. Chronic congestion. Constant pain under 
inner angle of right shoulder-blade, sallow skin, yellow- 
coated tongue, dull headache, constipation, fullness in region 
of liver. 

"Has high value as a hepatic remedy." Hughes. 
Nux V. Enlargement and induration, shooting, pulsative 
pains, excessive tenderness in region of liver, pressure in epi- 
gastrium and hypochondria, with shortness of breath and 
constipation. Active congestion from excess of stimulat- 
ing food or alcohol. 

Lachesis. Acute pain in liver, extending towards stom- 
ach. Cannot bear any pressure about hypochondria. 
Suitable in obstinate cases of drunkards. 

"Cured a very severe case of chronic congestion, with jaundice and 
pain." Jousset. 

GENERAL MEASURES. Often caused by atoo-abun- 
dant, highly-seasoned, and stimulating diet, and alcoholic 
drinks. Hence these must be avoided. Observe regularity in 
hours of meals, eat light, avoid tea, coffee, and " hearty ? ' 
food, and stimulants. 

HEPATITIS. 

PROGNOSIS. Grave. Unfavorable: — Abscess; emaci- 
ation; hectic: hepatitis following dysentery. Most recov- 
eries follow discharge of abscess through lung; next, intes- 
tine, intercostal space, cavity of pleura, abdominal wall, in 
order given, the latter being almost invariably fatal. When 
air obtains free access to cavity of hepatic abscess, favor- 
able result seldom follows. Multiple abscess unfavorable. 

LEADING REJIEIMKS. 

Aconite. Beginning of attack — violent inflammatory 
fever, with insupportable, shooting pains in region of liver, 
tossing and great restlessness. 

Belladonna. Oppressive pain in region of liver, ex- 
lending to chest and shoulders; distension of epigastrium, 
with difficult and anxious breathing, congestion of head, 
obscuration of sight, sensation of fainting, violent thirst, 
sleepless tossing about, nausea, retching, distressing vom- 



KEY NOTES OF MEDICAL PRACTICE. 



iting, continued fever, with high temperature. No nee 
after local pains abate. 

" Better adapted to this disease than Aconite." Baehr. 

Merrurius. Fullness and swelling in region of liver, 
with pricking, burning, oppressive pain, preventing pa- 
tient's lying on right side, worse on movement of the body; 
pain in shoulders, anorexia, agonizing thirst, jaundice, 
shivering, sometimes followed by sweating, but without 
relief. Acute parenchymatous inflammation. 

" Most important remedy in worst forms of acute parenchymatous 
hepatitis." Baehr. 

Bryonia. The paiDs in region of liver are sharp and 
shooting, with tension and burning, increased by touch, 
coughing or respiration, especially during inspiration, and 
much increased by motion. Violent, spasmodic oppres- 
sion of chest, rapid and anxious breathing, bitter taste, 
yellow-coated tongue, constipation, severe headache. Sub- 
inflammatory cases. 

Hepar s. For threatened abscess, or, after suppuration 
has begun. 

GENERAL MEASURES. When abscess has been 
made out, evacuate with aspirator. 

JAUNDICE. 

Aconite. Fever, stitches in liver, yellow skin, scanty, 
dark urine, clay-colored stools, local pain, inflammatory 
symptoms. Or, prostration, vomiting, oppression of chest, 
blue nails, cadaverous countenance, cold extremities, feeble 
pulse, collapse. 

"Has cured some malignant cases. 1 ' Jousset. 

Mercurius. Duodenal catarrh, with extension of the in- 
flammation to bile ducts. Complete jaundice. Skin very 
yellow, thickly-coated, flabby tongue, nausea, vomiting, 
loathing of food, grayish-white feces, diarrhoea, tenesmus, 
urine scanty and dark-red. Pain in region of liver. Icterus 
neonatorum. 

" One of the most frequently indicated remedies, with or without 
fever." Raue. 

Chelidonium. Yellowness of eyes and skin, pain in 
liver and right shoulder, bitter taste, tongue clean, of deep- 
red color, stool white, urine dark red, region of liver dis- 
tended and painful. 

" No better remedy." Hale. 

China. Gastro-duodenal catarrh, particularly after great 
loss of animal fluids, or in malarial jaundice. Oppressive 
headache, perverse appetite, with canine hunger, dingy- 
yellow complexion; liver swollen, hard and tender, with 
spasmodic, stitching pains. 

" Recurrent form." Lilienthal. 



CALC ULI — BILIARY. 



59 



Hydrastis. Gastro-dnodenal catarrh, sense of sinking 
and prostration at epigastrium, with violent and continued 
palpitation of heart. 

Podoph. Enlargement of liver, -with severe pain, urine 
scanty and dark-yellow, stools clay-colored, nausea and 
vertigo. In complication with gall-stones. Duodenal 
catarrh. 

Arsenicum. Malignant jaundice, the bile decomposed, 
poisoning the tissues; black or bluish patches on the skin 
" Especially valuable when from disorganization of the liver '« 
Hempel. 

Phosphorus. Malignant cases, nausea, epigastric ten- 
derness, numbness of extremities, liver swollen and very 
sensitive to pressure; chills, pulse weak and low; drowsy, 
comatose condition. Acute hepatic atrophy. 

Nitric ac. Chronic jaundice, enlargement and indura- 
tion of liver, obstinate constipation, fetid, dark-colored 
urine, sharp pain in pit of stomach. 

Sulphur. Chronic, organic disease of liver. 

Nux VOm. Chronic constipation, sedentary and intem- 
perate habits. 

Chamomilla. Acute, from fright or anger. 

Crotalns. Malignant. Typhus icterodes. 

Iodine. Chronic, and after abuse of Mercury. 

GENERAL MEASURES. Hot fomentations to relieve 
pain. Warm clothing. Light diet, broths, roast-apples, 
vegetables. Plenty of water. 

CALCULI — BILIARY. 

Berberis. Pain, soreness and burning in the biliary 
tracts, with tendency to gall-stone. Also to be given at the 
time of the attack, for pain attendant on the passage of 
gall-stone. 

Arsenicum. Severe attacks, the patient pallid and ex- 
hausted, covered with cold sweat, the syncope interrupted 
only by efforts to vomit. Give this remedy to excite 
reaction. 

Calf, carb. 30 Give frequent doses every fifteen minutes, 
during paroxysm, to relieve pain. 

" Dr. Drury's recommendation led me to try it. The effect of this 
remedy in the next case I had was something marvellous, and it has 
never failed me since. Drs. Bayes and Dudgeon have also borne testi- 
mony to its efficacy." Hughes. 

China. To correct tendency to formation. "I give 
usually China 6x, six pills twice a day, till ten doses are 
taken; then six pills every other day, till ten doses are 
taken, then every third day, till ten doses are taken, and so 
on, till at length the dose is taken only once a month. I 
have not failed to cure, in a single instance, permanently 



60 



KEY NOTES OF MEDICAL PRACTICE. 



and radically, every patient with gall-stone colic, who has 
taken the remedy as directed." Dr. David Thayer. 
Cfael. '" Has cured numerous cases." Hale. 

TO PREVENT RETURN. China, Berb., Chel., Nux c. 
Pod., Merc., Sulph. 

GENERAL MEASURES. At time of attack direct 
efforts to moderate the pain and set free the impacted 
calculus. Apply hot fomentations, or chloroform-liniment. 
A full, warm bath helps. Olive oil, taken in large quanti- 
ties, sometimes promotes easy passage of the stone. In 
severe cases failure to relieve excruciating pain may neces- 
sitate' resort to inhalations of Chloroform, or Morphine 
hypodermically. 

Diet. Eat sparingly of animal foods; abstain from use 
of fatty and saccharine substances. Do not have meals at 
too great intervals, as the gall-bladder should be frequently 
emptied. Carlsbad and Vichy waters have proved curative. 



DISEASES OF THE KIDNEYS. 



NEPHRITIS — ACUTE. 

Aconite. Acute idiopathic, from cold. High fever, rest- 
lessness, dark, scanty urine, stitches in region of kidney. 

Cantharis. High fever; urine scanty, high-colored, 
bloody, passed drop by drop, with scalding, burning pain, 
with tearing pains in loins. Very useful in joost-scarlatinal 
and post-diphtheritic nephritis. 

Apis. Renal pains, urine scanty, albuminous. Sudden 
oedema. Especially useful in post-scarlatinal nephritis, 
and the congestion of kidneys of pregnancy, with oedema. 

Terebinth. Passage of scanty, dark and bloody 
urine. " Coffee-ground " sediment in urine. 

" Almost infallible in renal congestion." Hughes. 

Belladonna. Shooting pains from kidneys to bladder; 
renal region very tender to pressure; urine orange-yellow, 
or bright-red, depositing a thick sediment. Important 
remedy for congestion of kidneys. 

Arsenicum. Urine scanty, dark-brown and albuminous. 
Great thirst and restlessness, pale, waxy skin, cedema of 
parts, or anasarca. 

" The best remedy in most cases of post-scarlatinal nephritis " 
Hughes. 

Hepai'S. Threatened suppuration. Cessation of the 
acute pain, sensation of throbbing and feeling of weight 



BKIGHT'S DISEASE. 



61 



in renal region; alternate chills and flushes of heat, followed 
by perspiration. 

GENERAL MEASURES. Absolute rest in bed. Hot 
fomentations to small of back. Drink large quantities of 
soft water. 

Diet. Milk and vegetables, avoiding meats and all 
stimulants. 

BRIGHTS DISEASE. 

PARENCHYMATOUS NEPHRITIS. 

PROGNOSIS. Acute, often followed by recovery : if it 
reach second stage (Degeneration), recovery very rare; third 
stcuje (Atrophy), invariably fatal. 

CAUSES OF DEATH. Uraemia; meningitis; peri- and 
endo-carditis; pneumonia. 

LEAI)I\di REJHEMES. 

Cantharis. Early stage. Urine scanty, albuminous, 
high-colored, scalding; aching pains across the loins. 
Urine contains a large quantity of epithelial cells. Head- 
ache, delirium, convulsions, coma. Most useful where 
descpaamation is considerable, and uriemia threatens. 

Terebinth. Idiopathic parenchymatous nephritis. 
Urine scanty, dark, smoky, bloody. Much albumen, and 
many blood-casts. Anasarca. Of no use in uraemia. There 
must be blood in the urine in order for this remedy to be 
indicated. 

Arsenicum. Large white kidney. Skin pale and waxy, 
partial or general dropsy, puffy appearance and debility. 
Urine scanty, albuminous, containing fat-globules, renal 
epithelium, fibrin casts, and a few blood-corjmscles. In- 
flammation of serous membranes. 

" Cases of cure by this remedy are numerous aud brilliant." Hughes; 

Phosphorus. Chronic tubular nephritis. Urine high- 
colored, high specific gravity, containing albumen, oil- 
globules, and exudation cells. 

'■ The best remedy in fatty degeneration." Hughes. 

RED GRANULAB KIDNEY. 

PROGNOSIS. A cure may be effected in early stage; 
later, patient may live for years, but finally fatal. 

CAUSES OF DEATH. Generally uraemia; may be from 
complications — pneunomia, etc. 

Plumbum. Cirrhotic kidney. Headache, dyspepsia, 
oedema of face and ankles. Urine — low specific gravity, 



KEY NOTES OF MEDICAL PRACTICE. 



small percentage of albumen, hyaline and granular casts, 
and a few blood-corpuscles. 

In 1876 I made a cure in an undoubted case of incipient renal 
cirrhosis, using Plumbum met. 6x trit. alone. The former patient is in 
good health at the present writing ( 1883), and has remained so all these 
years. In numerous other cases, which, however, were already 
chronic when coming under treatment, by the same remedy the dis- 
ease has invariably been arrested in its rapid course, with improve- 
ment of all symptoms, although the final result has, of course, been 
that to which the extensive and far-advanced degeneration must inev- 
itably lead. In a case at present in my wards in Cook County Hospital, 
an apparent cure has been effected.* 

SPECIAL, KKHKDI ES. 

Ara. Serous inflammations. 
Nux v. Dyspeptic vomiting. 
Cactus. Over-action of heart. 
Apocy. For excessive dropsy. 
Mere. C. Bronchitis in complication. 
Phos., Chel. Intercurrent pneumonia. 

GENERAL MEASURES. Adopt measures to keep 
the skin active, and promote free diaphoresis. Give 
vapor baths, or Turkish baths, being careful not to carry 
it to the extent of weakening the patient. Use, also, salt- 
water and alcohol sponge-baths. Let the patient be warmly 
clad, and avoid cold air, or sudden lowering of the bodily 
temperature. Take plenty of open-air exercise. 

Diet. Milk-diet best. Let patient gradually leave off 
all his ordinary food, until he reaches an exclusive milk- 
diet. Begin by drinking a quart of milk a day, and grad- 
ually increase the quantity from day to day until finally 
five or six quarts are taken daily. Divide the day into 
equal periods, and take a half-pint, or pint at a time. 
Keep it up for at least a month. 

AMYLOID KIDNEY. 

Amyloid degeneration of the kidneys belongs to a ca- 
chexia depending on tertiary syphilis or prolonged suppu- 
ration, and should be treated in accordance with the nature 
of the primary affection. 

REMEDIES. Pftos. etc., Nitr. ac, Merc, Kali iod. Sars.. 
Sil. 

CALCULI — RENAL. 

LITHIC ACID CALCULI. Lye, Nuoo v., Puis., Sars., 
Evp., Colch. 

Lycop. Disorders of digestion and derangement of 
liver. Lithic acid crystals (red sand) in the urine. 

•Since discharged cured. 



TJRJEMIA. 



63 



Nnx v. Disorders of digestion from high living; con- 
stipation. 

Diet must be carefully regulated. It must be simple, 
digestible and moderate in amount. Eat sparingly of 
meats — let the diet consist chiefly of vegetable food. If meats 
be eaten, take but very small quantity at any one meal. 
Avoid rich and highly seasoned dishes, and take no cham- 
pagne, spirituous or malt liquors. 

Regimen. An abundance of out-door exercise highly 
important, to supply system with oxygen. Keep up 
healthy action of skin by Turkish baths, and daily fric- 
tions with flesh-gloves. Drink large quantities of pure, soft 
water. Filtered rain-water is superior to all others. 

PHOSPHATIC CALCULI. Phos. ac, Aletris, Helonias, 
Ignatia, China. 

Diet. The diet should be nutritious and simple. Drink 
freely of pure water. 

Regimen. Exercise, change of scene, and mental rest 
important. Attention to bladder important — do not let 
urine be long retained, and treat first indications of vesi- 
cal catarrh. 

OXALATE OF LIME CALCULI. Nitro-muriatic acid, 
Uranium Nitrate. 

Diet. Avoid the use of rhubarb, asparagus, sugar, oils 
and fats, and spirituous or malt liquors. Drink no " hard" 
water — i. e., water containing lime. 

Regimen as in previous form. 

Berberis tinct. Give during the attack of renal colic, 
to promote passage of stone. 

GENERAL MEASURES. During passage of stone, 
the intense suffering of patient must be relieved. Apply 
hot fomentations over loins and lower abdomen. Put 
patient in hot hip-bath. Give enema of starch and Laud- 
anum', gtt. xxx. to xl., and let patient get effects of the 
opiate. Inhalations of Chloroform, if urgency demands. 
Subcutaneous injections of Morph. sulph. Drink large 
quantities of bland liquids during the attack. If it be an 
uric-acid stone, give liquor potassii citratis, fc,ss, every 
three hours. 

UREMIA. 

PKOGNOSiS. Unfavorable: Setting in with great vio- 
lence; convulsions and coma; if kidney degeneration far 
advanced. Favorable: Those cases in which the impediment 
to the excretion of the urine can be speedily removed. 

Cantharis. Uraemia secondary to congestion or inflam- 
mation of the kidneys. Give frequent doses. Tereb. if 
Canth. fail. 

Digitalis. If heart's action weak. 



(It 



KEY NOTES OF MEDICAL PRACTICE. 



Apocynuni. Ursemia following dropsy. Administer 
remedies subcutaneously if patient unconscious. 

GENERAL MEASURES. Resort to every possibls 
means to restore action of kidneys. Hot compresses or hot 
poultices over loins: hot pack, to promote diaphoresis. If 
there be any urine in bladder, use catheter. If it occur in 
puerperal state, terminate labor as soon as possible. For 
convulsions, Morphine, gr. % — J4 hypodermically, or Potasii 
bromid. per rectum. Free purgation may be procured by 
Oleum tiglii, one drop 011 the finger, touched to back of the 
tongue. 

Diet. After attack give nourishing diet, especially a free 
milk-diet. 



DISEASES OF THE BLADDER. 



CYSTITIS— ACUTE. 

Aconite. Only when there is much erethism or fever. 
Dry, hot skin, thirst and restlessness; frequent and violent 
urging to urinate, with burning in bladder. Painfulness in 
region of bladder. 

Cantharis. Violent pains and burning heat in bladder. 
Very frequent micturition, with tenesmus vesica?. Burning 
and cutting pains, so severe patient screams aloud. Con- 
stant desire to urinate, with scanty emission of dark or 
bloody urine. 

Belladonna. Region of bladder very sensitive. Urine 
hot and red. Involuntary dribbling of urine. Great ner- 
vous irritability. 

Camphor. The best remedy for strangury, especially 
useful if the attack was brought on by toxic doses of Can- 
tharides. 

Cannabis. Especially gonorrhoeal cystitis. Its symp- 
toms are similar to those of Cantharis, but less intense. It 
may be given in acute cystitis if improvement does not 
follow the use of the former in twenty-four hours. 

CYSTITIS CHRONIC. 

(Iiimaphilla. Dysuria, with mucous sediment in urine. 

" The best remedy in the chronic form." Ruddock. "I have often 
used it with advantage. From one to live drops of the mother-tincture 
seems to be the most suitable d06e." Hughes. 



ENURESIS— HEMATURIA . 



66 



Mercurius. Fever, with chilly creepings and great sen- 
sitiveness in region of bladder. Urine turbid, fetid, con- 
taining pus. Also in gonorrhceal cystitis. 

Sulphur. Obstinate chronic cases, urine very fetid. 

CONSULT — Dulc, Senecin, Apis, Puis. 

GENERAL MEASURES. Acute.— Hot hip-bath, or 
hot fomentations, with absolute rest in horizontal position. 
Chkonic. — Great benefit often follows washing out the 
bladder. Use small quantity of water at blood-heat, lightly 
colored with Hydrastis tinct. Force it in gently and slowly. 
The best method is to use a fountain syringe, with a flexible 
soft-rubber catheter. This can be used] for either male or 
female patients. 

Diet. Prescribe a diet which shall keep the urine as free 
from solids as possible. In acute cases eat but little meat, 
and avoid the use of all stimulants, wine, spirits, beer, tea, 
coffee, spices. Drink large quantities of pure soft water, 
such as Poland or Waukesha water. Filtered rain-water is 
best. 

ENURESIS. 

Sulphur. Nocturnal enuresis, copious discharge. 

" Should begin the treatment of every case." Jahr. 

Belladonna. Paresis of sphincter vesicce; may be neces- 
sary to give several drops of mother-tincture as a dose, for 
children. 

Causticum. Involuntary passage of urine at night 
when sleeping. Passage of urine when coughing or sneez- 
ing. 

Eqm'setum. Has proved curative in many cases of noc- 
turnal enuresis. 
Cina. When traceable to worms. 

GENERAL MEASURES. Child should sleep on hard 
mattress, with light covering. Avoid hot drinks and highly- 
seasoned food, late in the day. 

HEMATURIA. 

Terebinth. The blood intimately mixed with the urine, 
which has a dirty, brown-red, or even blackish color. 
Burning and drawing pains in kindeys, spasmodic urging 
and pressing in region of bladder. 

"Occupies the first place." Hughes. 

Cantharis. Violent, cutting, pressing and crampy pains 
in the bladder, extending into the urethra and kidneys; 
strangury and burning. Blood discharged drop by drop. 

"One of the chief remedies." Hartmann. 
3 



KEY NOTES OF MEDICAL PRACTICE. 



Millefolium. Pain in renal region, chilliness; the blood 
forms a sediment in bottom of vessel, like a bloody cake; 
pressive pain in urethra during flow of blood. 

" Has been used successfully." Hering. 

Hamamelis. Haemorrhage from passive congestion of 
kidneys, with dull pain in renal region. 

Belladonna. Renal hyperemia from cold. 

Nitric ac. Active haemorrhage after Mercury; tenesmus 
vesicae after micturition. Dissolution of blood corpuscles. 

Arsenicum. Urine scanty, very dark, mixed with pus 
and blood, and rapid decomposition of it in the vessel. 
Wide-spread burning pains in urinary organs. 

" Efficient in both acute and chronic." Baehr. 

Camphora. Hatmaturia after excessive use of canthar- 
ides. 

GENERAL MEASURES. Absolute rest; promote 
action of skin by vapor baths; let patient drink large 
quantities of soft water; copious injections of warm water 
often afford great relief. When bladder is filled with thick 
clots of blood, which cannot be passed, or drawn through a 
catheter, force into bladder two ounces of warm water, con- 
taining in solution, five drops of Hydrochloric acid and 
sixteen grains of Pepsin; in a few hours the contents of 
bladder will readily pass through the catheter. 



DISEASES OF THE NERVOUS SYSTEM. 

HYPEREMIA OF THE BRAIN. 

Belladonna. Face red and congested, injection of con- 
junctivae, photophobia, extreme sensitiveness to the slight- 
est noise, sudden starts and jerks, general hyperesthesia. 
Tendency to delirium. 

Veratrum vir. Cerebral hyperemia accompanying 
febrile conditions. Headache, violent throbbing of the 
carotids, sensitiveness to sound and light, flushed face, ting- 
ling and prickling in the lower limbs, full, hard, bounding 
pulse. 

"One of the most powerful remedies for cerebral hyperemia." 
Baehr. 

Aconite. The result of cold, or violent emotion, with 
hot, dry skin and great excitement of the circulation. 

Gelsemium. Passive hyperemia, and hyperemia occur- 
ring during dentition. 

Glonoin. Sudden and intense congestion, with violent 
headache; absence of fever. 

Arnica. When from injury. 



CEREBRAL MENINGITIS. 



( ' E K E BRA L MENING ITIS. 

, PROGNOSIS. Grave. Unfavorable:— Tonic spasms; 
difficult deglutition; incontinence of fteces and urine; ster- 
torous respiration; stupor and coma. 

LEAIMX(i REMEDIES. 

Aconite. In the initial stage; fever, dry, hot skin, great 
arterial tension, face red and bloated, burning in brain, 
with sensation as if it were moved by boiling waiter. Great 
restlessness and anxiety. 

•• As soon as pulse becomes slower, and symptoms of exudation set in 
Aconite no longer indicated." Baehr. 

Belladonna. Face red and bloated, with red, sparkling 
eyes, boring of head into the pillow, great sensitiveness to 
light and noise, with general hyperesthesia; violent throb- 
bing of the carotids, loss of consciousness, violent delirium, 
convulsive movements of the limbs; vomiting; involuntary 
stools and urine. 

" A disposition to perspire constitutes a valuable indication in favor 
of Belladonna as compared to Aconite." Baehr. 

Bryonia. After effusion has set in. Mild delirium; 
severe, shooting and tearing pains in the head, with sharp 
screams; livid face, chewing motion of the jaws; stupor. 

" When the stage of excitement is merging into that of depression 
and stupor.'' Hughes. 

Helleborns. Eyes rolled up, lids half closed; face pale, 
breathing slow and deep; sighing; soporous sleep, with 
screaming and starting; automatic motions of one arm and 
one leg; jerking and convulsive movements. Follows Bel- 
ladonna. 

" The proper period for its application has arrived if reaction has 
almost entirely ceased and the symptoms of paralysis are more or less 
completely developed." Baeht. 

Apis mel. Convulsions; sopor, interrupted by piercing 
shrieks; bending back, and rolling of the head; grating of 
teeth. Follows well after Bryonia. 

Sulphur. " Appropriate as a means of assisting the de- 
laying resorption of the exuded fluid; hence in the stage of 
paralysis, after it has continued for a time without any 
perceptible change." Baehr. 

Arnica. Especially when of traumatic origin. Also, to 
promote resorption of serous effusion, after inflammation. 

"Absence of all signs of reaction contra-indicates this agent de- 
cidedly." Baehr 

Zi ii( ii in. Patient unconscious; eyes half-closed; dilated, 
insensible pupils; extremities, or whole body, cold: blueness 
of hands and feet; impeded respiration; small, weak pulse. 
Inflammation has ceased, and effusion, with cerebral torpor, 
remains. 

"Even in advanced paralysis, with general coldness, it has been 
nown to excite salutary reaction." Hughes. 



68 



KEY NOTES OF MEDICAL PRACTICE. 



SPECIAL, REMEDIES. 

Opium. Deep coma. 
Merc, Kali hyd. Syphilitic cachexia. 
Rhus. With erysipelas and low fever. 
Hyos. Severe cerebral pains, delirium, aberration ol 
sight. 

GENERAL MEASURES. Keep sick-room darkened^ 
well ventilated and very quiet. Raise head on a thin pillow. 
In severe attack, cut the hair. Apply cold to head. To be 
of service cold applications must be continuous — not warm 
at intervals. Use bladder, or small rubber bag, half full of 
pounded ice; or, cover head with soft cloth and conduct to 
it a constant, small stream from vessel of cold water, by 
syphon of small rubber-tube or cotton wicking. Great 
caution necessary. Apply only in stage of excitement, 
never after stage of depression has set in. Throughout 
attack, keep extremities warm. During convalescence pa- 
tient must be kept free from all excitement or disturbance; 
do not talk to children. 

Diet. During fever give liberally of cold water to slake 
thirst. Barley-water, milk and water, and broths should be 
given as soon as depression sets in. In convalescence re- 
turn to solid diet cautiously. 

APOPLEXY. 
EEAI>lX<,i REMEDIES. 

Aeon. Full, strong pulse, plethoric subjects, great arter- 
ial excitement. 

"You will be astonished at the rapidity with which the beneficial 
results will manifest themselves under this potent drug." Hughe*. 

Bell. Great cerebral congestion, red, swollen face, throb- 
bing of cerebral vessels, dilatation of pupils, conjunctiva 
red and injected, convulsive movements of face or limbs, 
involuntary discharge of urine. To be of service, must be 
given early, when the effusion is still attended by violent 
symptoms of congestion. 

" Sometimes has a magic effect." Baehr. 

Opium. Profound stupor, bloated, dusky-red face, stertor 
and irregular breathing, stupid, besotted countenance, con- 
vulsive motion of extremities, patient moans and groans, 
is hard to arouse, face covered with profuse, cold sweat. 

" This drug is of great value." Hartmann. 

Arnica. No arterial excitement or cerebral congestion. 
Sudden attack, with stupefaction, sighing and muttering, 
involuntary discharges. Also, to promote resorption of 
effusion, to be given after the attack, with Bell., if signs of 
cerebri tis. 

" As remedy to promote resorption, Arnica occupies first rank." 
Baehr. 



APOPLEXY — ALCOHOLISM . 



69 



SPECIAL, REMEDIES. 

Nlix v. Congestive condition of brain favoring apo- 
plexy. For those of sedentary habit, who have indulged in 
rich diet and alcoholic stimulants. 

Sulph. To promote resorption, "comes in where the 
action of Arnica terminates." 

Plios. Retards degeneration of arteries. 

FOR PREDISPOSITION. Nux v., Phos., Baryta, Lack., 
Gels., Hyos. 

FOR AFTER-EFFECTS. Cowl, Zinc, Cup,:, Plumb.. 
Cocculus. 

Faradization, to restore paralyzed muscles. 

GENERAL MEASURES. Loosen all tight clothing, 
especially about neck; remove patient to cpjiet, cool place, 
let him lie with head and body raised, and give plenty of 
fresh air. Rub extremities with heated flannels, and apply 
hot bottles. Apply warm cloths to head — cold applications 
do harm, especially if face pale and surface cool. Venesec- 
tion worse than useless. 

Diet. Of great importance. Avoid over-eating, rich 
food, and stimulants of all kinds. At no time should full 
animal diet be indulged in. 

Avoid all excitement, fits of passion, over-exertion, sud- 
den changes of temperature, exposure to hot sun, over- 
heated rooms, hot baths, wet feet, and excesses of whatever 
kind. 

ALCOHOLISM— ACUTE. 

SYNONYM: Delirium Tremens. 

Hyoseyamus 1\. Delirium mixed — loquacious, furious, 
muttering and incoherent; pulse small and quick, very 
compressible; skin cold and clammy. 

"Hyos. most commonly useful; rare that the delirium is inflamma- 
tory enough for Bell., or sufficiently maniacal for Strum." Hughes. 

Opium. Comatose condition; loud, stertorous breath- 
ing; loss of consciousness and sensation. 

Ant. tart. Much mucous gastric disturbance with the 
attack, and profuse cold sweat. 

Arsenicum. Great irritability of the stomach, great 
prostration, and muscular tremors. 

Ammonia. To "sober up" one who is " pretty tight," 
give a dose consisting of one drachm Spts. Amm., diluted 
in a little water. 

GENERAL MEASURES. A cup of strong coffee is 
often of great benefit. It is highly important that the 
strength be maintained by a nutritious diet, as the danger is 



70 



KEY NOTES OF MEDICAL, PRACTICE. 



from exhaustion, Give soups, beef-tea, warm milk, coffee, 
egg beaten up in coffee or milk. A plentiful sprinkling of 
red-pepper may be used in seasoning the food. 

Use as little violence as possible; employ only gentle 
compulsion, trying to soothe and quiet the patient by kind 
words, keeping him as quiet as possible, and, if you can 
manage it, in a darkened room. Have the windows securely 
fastened, and help at hand to summon in case of necessity. 

ALCOHOLISM CHRONIC. 

Nux vom. Often indicated. A few drops of the lx in 
frequently-repeated doses for bad effects following a 
"spree." Very good for morning-vomiting, trembling 
hands, and other nervo-muscular affections of drunkards. 

Phos. zinc. In chronic alcoholism, for nutrition of ner-"* 
vous centres. 

Capsicum. Ten drops of the tincture in a little water 
for atonic dyspepsia of drunkards. 

Arsenic. For the morning-vomiting, gastritis, prostra- 
tion, muscular tremors. 

Moschus. The best remedy to allay the craving. 

GENERAL MEASURES. To correct the habit, the 
use of alcoholic stimulants m ust first be entirely given up^i 
As substitute, Tr. Cinchona rubra, may be given, ateaspoon- 
ful dose, two or three times daily; or, 
1$ Lupulinae, fl. ext. 

Tr. Capsici, equal parts. 
Dose. 1 or 2 tsp. p. r. n. 

This, also, is an excellent substitute for the alcoholic 
stimulant. 

Diet. A most important part of the treatment. Have 
patient eat freely of fruits and vegetables, and drink milk, 
lemonade, fruit-flavored syrups, and water. 

OPIUM-HABIT. 

Diminish dose by insensible degrees, without the knowl- 
edge of the patient. Get control of patient and deal out to: 
him his daily allowance. If patient has hypodermic- 
syringe, its use and custody must be given up to some one 
else. If daily quantity is not more than four grains, the 
use of syringe must be given up at once, and a proportion- 
ate quantity — i. e.. three times as much — given by the stom- 
ach. When per diem quantity is from one scruple to one 
drachm, considerable reduction must be made before the 
syringe can be abandoned, but it must be dropped at the 
earliest possible moment. The rate of reduction should 



HEADACHE. 



71 



not be greater than 1-16 gr. hypodermically, or 1-5 gr. by 
stomach, each three to eight days. The necessary time 
must be given, even though it take a year. 
"Never stop opiate suddenly." Bat tholow. 

Mix the dose of Morphine with a quantity of the lx or 2x 
trituration of Nux v., or Quia, sulph., gradually lessening 
the proportion of the former and increasing that of the 
latter, until the one comes to be substituted for the other. 
Et Laudanum be taken, pursue same plan, substituting Tr. 
Coca, Erythoxylon. 

Diet. Success promoted by correcting abnormal condi- 
tion of digestive functions by appropriate remedies. Im- 
portant to keep patient well-nourished. If digestion good, 
and food can be taken and assimilated, difficulties of treat- 
ment reduced one-half. Give milk, eggs, animal broths, 
steaks, chops and other substantial food. Important to 
have occupation for mind and body. 

Absolute control of patient is necessary by any method, and easier 
to obtain by the one here given than by any other. 



HEADACHE — CONGESTIVE. 

Aconite. Fullness and heavy feeling, as if everything 
would push out of forehead. Burning headache, as if brain 
agitated by boiling water. Vertigo, with nausea and van- 
ishing of sight. Arterial tension and excited circulation 
throughout the body. 

Bell. Intense headache, aggravated by noise, motion, 
moving the eyes, contact, and even coughing. Great con- 
gestion of head, with throbbing of carotids. Jerking head- 
ache, extremely violent on walking — pain increased at every 
step. Stabbing as if with a knife, from temple to temple. 
Burning of eyes, and pain as if eyeballs would start from 
their sockets. 

Verat. vir. Intense cerebral congestion, feeling as if 
head would burst open, accompanied by nausea and vomit- 
ing. Headache proceeding from nape of neck. Heart 
beats loud and strong, with great arterial excitement. 

Glon. Active cerebral congestion. Violent throbbing, 
pulsating headache, with fulness and pressure in head. 
Pain so severe as to drive to frenzy. Patient grasps his 
tiead, and rolls and cries with agony. Headache from ex- 
posure to heat of sun. 

China. Deafness, noises in ears. 

Cat't. Heavy presninr/ on vertex. 

Opi. Passive congestion — sleepiness. 

Gels. Passive congestion — giddiness. 

Bry. Frontal; dyspepsia — constipation. 

NllX V. Occipital, with dyspepsia and constipation. 



72 



KEY NOTES OF MEDICAL PRACTICE. 



HEADACHE— NERVOUS. 
(HEMICRANIA.) 

Bell. Red face, great sensitiveness to noise and light. 
Right-sided, aggravated by slight jar. 

" The best medicine if of recent origin." Hughes. 

Sepia. Chronic cases. Skin yellowish under the eyes; 
•women with disordered sexual function, leucorrhoea, irregu- 
lar menstruation, scanty, preceded by pain. Headache 
generally occurs about time of menses. 

" Sepia has largest and most unanimous testimony in its favor as a 
radical remedy for this disease." Hughes. 

Ignal ia. Headache as if a nail were driven in side of head. ' 
Periodical. Pain usually semilateral. Persons of highly 
nervous temperament, or in those whose nervous system 
has given way to anxiety, grief, or mental work. 

NllX V. Sedentary habits, habitual constipation, sensa- 
tion as if skull would split, worse in open air, during motion 
and stooping. Irritability of senses. 

"A leading remedy in hemicrania." Baehr. 

Coffea. Great nervousness, exaltation of senses and in- 
somnia. One-sided headache, as from a nail driven into 
parietal bone. Useless in case of coffee-drinkers. 

Arsenicum. Neuralgic and periodic headache, migraine, 
and headache from abuse of quinine and from miasmatic 
influences. Great weight in head, particularly in forehead 

Gelsemium. Appears suddenly, with dimness of sight, 
or double vision; vertigo, great heaviness of head, bright- 
red face, dull, heavy expression of countenance, full pulse, 
general malaise. 

" Neuralgic headache after cerebro-spinal meningitis." King. 

Amyl nit. Pallor of face. Headache which increases in 
severity, and then abates, again and again. 

GENERAL MEASURES. All victims of hemicrard 

must give up the use of coffee. 

NEURALGIA. 

Aconite. — Acute idiopathic, from cold. Face red and hot] 
pains very severe, lancinating, pulsating — almost intolera-] 
ble at night, with great restlessness. Must be acute congui 
tion or active inflammation. 

"Invaluable in recent cases." Hughes. 

Belladonna. Violent cutting pain, red shining swelling^ 
congestion of face, eyes injected, lachrymation, great nerv 
ousness and restlessness, palpitation of heart. Motion and 
contact exceedingly painful. Pains appear in evening, 
most violent towards midnight. 



NEURALGIA — SCIATICA . 



7.3 



Colocynth. Tearing, tensive pain, greatly aggravated 
by every motion of the facial muscles, better from warmth, 
attended by inflammatory heat and swelling. Acute neural- 
gia, from cold. 

Spigelia. Neuralgia of trigeminus. Pain jerking, tear- 
ing, sometimes periodical, always attended by feeling of 
anxiety at heart, and great restlessness. Aggravated by 
slightest contact, by motion or stooping. Face pale. Of 
no use in chronic cases. 

" Deserves the first place." Baehr. 

Arsenicum. Idiopathic neuralgia. Burning, agonizing 
pain, accompanied by great restlessness and anguish. Inter- 
mittent, with tendency to periodic return. Worse from cold, 
easier during exercise. As a consequence of malaria, or in 
those of debilitated condition. Dose: — Acts best in high 
attenuations. 

"Quiets nervous pain better than any other medicine." Baehr. 

Iris vers. Neuralgia of head, temples and eyes, begin- 
ning in the morning and lasting for hours, causing burning 
distress in epigastrium, and vomiting. The entire scalp 
and face are involved, with sharp, shooting, cutting pains. 

(ids. Malarial origin. 

Rhus. After getting wet. 

Cedron. Marked periodicity. 

Verat. a. Icy coldness of part. , 

Hep. S. After abuse of Mercury. 

Bry. Intercostal, worse on motion. 

Pills. In lymphatic subjects; jerking pain. 

Phos. Tic-douloureux from nervous debility. 

Kali bi. Supra-orbital, with gastric disorder. 

Chel. Right supra-orbital, with liver disorder. 

Chilin. Pain, aggravated by the slightest touch. 

Kalinin. Neuralgia affecting one-half of the face. 

GENERAL 3IEAKrnES. Hot applications some- 
times relieve. Paint the course of nerve with mother- 
tincture of Aeon, or Bell. Chloroform-liniment locally. 
Dip a needle in oil-o'f-peppermint, or oil-of-cloves, draw 
it along course of affected nerve; sometimes has a magic 
effect. Protect the part from exposure to cold or damp — 
wear warm clothing. Best important for those who are 
over-worked. Galvanism often cures. 

Diet. In chronic cases, and debilitated subjects, an 
abundance of nutritious food. Cod-liver oil, and other ani- 
mal fats, very important — butter, cream, etc., should enter 
largely into the diet. 

SCIATICA. 

Chamomilla. Pains intolerable, drawing and tearing in 
character, with paralytic sensation. 

" Will often cure in young persons of nervous temperament." 
Hughes. 



74 



KEY NOTES OF MEDICAJ* PBACTICE. 



Rhus. Brought on by exposure to wet, straining and 
lifting. Pains worse when lying quietly, relieved by motion. 
Numbness, formication and stiffness. 
" In chronic cases rarely fails." Ruddock. 

Colocynth. Shooting, tearing pains, worse from motion 
and pressure. Pain sets in suddenly, is constant, becoming 
at times intolerable, felt most in daytime. 

" Has always enjoyed high repute." Hirjhea. 

Arsenicum. Burning pains, attended by anguish and 
restlessness, worse at night. Chronic cases. 

Actea. Hysterical subjects; ovarian or uterine compli- 
cations. 

Lycopodium. Coxalgia, with violent jerks of the limbs, 
stiffness, weakness and formication. Obstinate, chronic 
cases. 

GENERAL MEASURES. Apply heat; cover part 
with flannel, and run over it with a hot sad-iron. The 
battery should be tried in obstinate cases. Acupuncture 
often relieves. 

TETANUS. 

PROGNOSIS. If access slow, spasms mild, paroxysms 
short, recurring at long intervals, patient can sleep, and 
temp, not over 101" F., favorable. Temp, over 101 F„ 
unfavorable ; 103" F. or over, dangerous. 

L,EAI>IX<i BEHEDIE8. 

Strychnia. Intermittent fits of sjiasm, with bending 
body backwards, and disturbed respiration. Extreme stiff- 
ness of limbs, hardness of muscles, full consciousness 
during the spasm. The spasm excited by the slightest touch. 
Dose: — lx or 2x trit. 

Aconite. Idiopathic tetanus, excited by exposure to cold ' 
or wet. Frequent alternation of redness and paleness of i 
face, distortion of eyes, body bent backwards, face covered 
with cold sweat, rigidity of muscles of jaws and neck. 

" Its spasms are more continuous than those of Strych., and less de- \ 
pendent on reflex excitement." Hughes. 

Hydrocyanic acid. Lockjaw; bloating of face and j 
neck; protruded, glistening eyes; body bent forward or 
backward; irregular pulse. 

Belladonna. Constriction of throat; tightness of chest; 
grinding of teeth; clenching of jaws; distortion of face,] 
mouth, foaming: obstructed swallowing; renewal of spasm I 
on attempting to drink. 

Cicuta. Trismus from injuries to head. . 

Rhus. From wounds of joints or tendons. 

Ignatia. Extreme opisthotonos; from fright. 

" We should give tolerabfy large doses of the remedy employed. 
Repeat frequently." Hughes. 



EPILEPSY — CHOREA — HYSTKKIA. 



7.-, 



GENERAL MEASURES. Keep room at comfortable 
temperature, the patient very quiet, and allow no draft or 
cold air to strike him. 

Diet. Give abundant nourishment. Give four ounces 
of milk every two hours; one egg, with milk, morning, 
noon and night; if pulse indicates great exhaustion, give 
nutrient enemata in addition. If jaws locked, pour liquid 
food between jaws and cheek. 



EPILEPSY. 

Belladonna. Recent cases. Cerebral congestion during ■ 
and between the paroxysms. Young and sanguine subjects, 
and for petit mal. 

" Will often be found efficient." Baehr. 

" In cases of some standing, Calcarea needed to complete the recov- 
ery." Hughes. 

Cuprum. Violent convulsions, occurring at night. 
" Occupies the first place among our remedies." Jousset. 

CONSULT — Ignatia, CHcuta, Cocculits, Strychnine, Opium, 
Argentum nit., Nux vomica. 

GENERAL MEASURES. Inhalations of Amyl Nitrite 
to ward off a threatened attack. During attack loosen 
clothing, and keep patient from injuring himself. Pressure 
on both carotids, which makes pressure on cervical sympa- 
thetic and par vagum nerves, will often shorten attack. In 
female patients, pressure on ovarian regions has like 
effect. When convulsions cease, draw tongue forward and 
turn head to one side, that the half-paralyzed tongue may 
not fall on larynx. Let patient rest. 

CHOREA. 
SYNONYM: St. Vitus' Dance. 

LEADING REMEDIES. Tgnatia, Actea, Arsenicum, 
Ferrum, Cuprum, Agaricus, Aconite. 

Galvanism, the constant current, has cured many cases. 



HYSTERIA. 



LEADING REMEDIES. 

Ignatia. Attack preceded by sensation of lump in 
throat followed by sense of suffocation, spasmodic eructa- 
tion, convulsive movements of arms and legs, clenching ot 
hands. Alternate flushing and pallor, yawning and sighing. 

" Its continued use modifies the morbid impressionability. " Hughes. 



KEY NOTES OF MEDICAL PRACTICE. 



Moschus. Great anxiety, palpitation of the heart, ten- 
dency to fainting, headache, feeling of constriction of chest, 
and general chilliness, and copious flow of colorless urine. 

" In low dilutions, will sometimes arrest and always shorten par- 
oxysms." Hughes. 

Asafoetida. Sensation as of a ball rising in the throat. 
Nervous palpitation. The throat symptoms predominate. 

Pulsatilla. Patients of mild, sensitive, tearful disposi- 
tion, frequent derangement of menstruation, the attacks 
being characterized by tearfulness, or fits of crying, without 
assignable cause. 

Aurum. Melancholia. 

Sepia. Chlorosis; leucorrhcea. 

Actea. Depending on menstrual suppression. 

Platina. Uterine derangements. Nymphomania. 

G ENERAL M EASURES. In attack— Loosen clothing, 
give air; sprinkle face with cold water; give Moschus. 

Regimen. Avoid tight clothing, excitement or emotion; 
take open-air exercise; observe regular habits, early hours, 
eat plain food; avoid stimulating diet. Correct uterine 
and sexual disorders. 

CONVULSIONS. 

Belladonna. Great cerebral congestion, hot, flushed 
face, violent throbbing of carotids, drowsy after the spasm, 
starting and jerking in sleep. Great vascular erethism. 

" Seldom happens that a second attack will occur after administer- 
ing Be/?." Baehr. 

Ignatia. Tonic spasms, very violent; during dentition, 
in those of highly nervous organization, from fright or 
grief. Of spinal rather than cerebral origin. 

Chamomilla. Extreme sensitiveness, with great irrita- 
bility; one cheek red and hot; bloated bowels; restlessness, 
with moaning and groaning. 

Cuprum. Ancemic condition. Shrill cries during attack, 
drowsy and stupid in intervals; bloated abdomen, involun- 
tary, thin discharge from bowels. 

CONVULSIONS FROM 

Passion. Chamomilla. 

Injury. Arsen., Cic, Bell. 

Worms. Cina, Merc, Cicuta. 

Fright. Op., Hyos., Aeon., Bell. 

Stomach disturbance, ip., Nux v. 

Incipient Brain-affection. Bell., Gels., Ver. v. 

GENERAL MEASURES. Lose no time— have child 
stripped and put in warm bath (90° F.); apply to head 
large sponge wrung out of cold water. Remain in bath ten 
or fifteen minutes. 



L A.RYNGTSM US STRIDULUS — HYDROCEPHALUS. 



In emergency, if no other remedy is at hand, give Cam- 
phor, by inhalation, or a drop in a little sweetened gum- 
water. Lance gums if swollen and inflamed. During 
spasm, administer A nvjl, Nitrite, by inhalation. 

If child is robust and apparently healthy, the attack 
is probably reflex; if weakly, wasted, or cachectic, it is 
probably from the brain. 

If patient is an infant reduced by exhausting diarrhoea, 
remain in bath but two or three minutes, and do not put 
cold water to head; give stimulants of brandy and milk, 
freely. 

LARYNGISMUS STRIDULUS. 

Aconite. Attack excited by cold, dry air. Spasm of 
larynx, severe dyspnoea, febrile symptoms. 

"Eminently specific." Hempel. " Of priceless value." Ruddock. 

Chlorine. Spasm of glottis, a succession of crowing 
inspirations, each followed by an ineffectual effort at expi- 
ration, the chest inflated, with turgescence of face, more or 
less complete coma, followed by relaxation of the spasm. 
Dose: — Prepare weak solution in water, so that the odor of 
the Chlorine can just be detected. Teaspoonful at a dose. 
Prepare fresh frequently. 

" I have used it with great advantage." Dunham. 

Iodine. Child rachitic, with swelling of bronchial 
glands. 

" To be preferred to all other remedies, as long as general organism 
has not become too much reduced." Bathr. 

Belladonna. Red face, arterial excitement, cerebral 
congestion. 

Sambucus. Burning, red, hot face, hot body, cold hands 
and feet, profuse perspiration on face and body. 

Moschns. Give by inhalation at time of attack, to cut 
short paroxysm. 

GENERAL MEASURES. Apply hot compress to 
throat — renew frequently. Sponge chest with cold water. 
Give Moschns. Two or three times a day give neck and 
chest cold sponging. 

HYDROCEPHALUS — ACUTE. 

PROGNOSIS. About seven-eighths of all cases are 
fatal. Unfavorable:— Deepening stupor; eyes dim, glazed, 
and turned upwards; convulsions. Patient may die in 
coma or convulsion. Favorable: — A copious outbreak of 
perspiration, diminished oppression of breathing, increased 
flow of urine. 



78 



KEY NOTES OF MEDICAL PRACTICE. 



LEADING REMEDIES. 

Belladonna. Heat of head, throbbing carotids, pain in 
head, buries head in pillow, extreme sensibility to light and 
noise, eyes red, sparkling and protruding, violent delirium, 
drowsiness, stupor, with occasional frantic screams, convul- 
sions, vomiting, and occasional involuntary evacuations. 
The medicine until effusion sets in. 

" The sheet-anchor, after vomiting sets in." Hughes. 
Bryonia. Impending effusion. Face dark " crimson- 
red," dry lips, dry, brownish tongue, hasty, impetuous 
drinking and swallowing, constipation, suppression of 
urine, dry heat, especially of head, drowsiness, chewing 
motion of jaw. 

Helleborus. After exudation. Rolling the head, auto- 
matic motions of one arm and one leg, soporous sleep, 
with screaming and starting, lower jaw sinks down, chew- 
ing motion of mouth, squinting, pupils dilated, forehead 
wrinkled, and covered with cold sweat. 

"One of the most important remedies." Laurie. 

Digitalis. Sometimes called for in second stage, after 
effusion. Pulse slow, weak and irregular. Sopor, slow, 
heavy breathing; sleep with frequent startings, convulsions. 
" Has high repute." Hughes. 

Cuprum. Hydrocephalus following catarrhal fever, nr. 
metastasis during exanthematic fever. Stage of effusion. 
Hot head, deep sopor, with twitching and jerking of the 
limbs, coldness of the hands, and bluish appearance of 
fingers. 

Sulpli. " If others fail." Hughes. 

Iodine. " Incipient stage." Jousset. 

Calc. e. " Scrofulous subjects." Jahr. 

Dosf.:— "Our best observers unite in affirming that frequently- 
repeated doses of low attenuations are preferable in this disease." 
Baehr. 

HYDROCEPHALUS — CHRON I< . 

Calc. c. Scrofulous diathesis. 
Ars. iod. Tubercular cachexia. 

Sulph., " with Calc. e., accomplishes almost incredible 
results." Jousset. 

GENERAL MEASURES. Cod-liver oil, nourishing 
diet, fresh air and sunlight. 



DISEASES OF THE SKTK 



79 



DISEASES OF THE SKIN. 
lkadim; remedies. 

Arsenicum. The cutaneous affections to the treatment 
of which Arsenicum belongs are those which involve the 
more superficial structures of the skin; hence, in branny, 
scurfy eruptions, and those marked by the presence of 
papules, or minute vesicles, on inflamed bases. It should 
be used for dry, scaly eruptions, accompanied by intense 
burning of the surface. 

Varieties. Pityriasis; Psoriasis; Herpes zoster; Pru- 
rigo; Eczema (chronic); Lichen; Pemphigus; Urticaria; 
Impetigo; Ecthyma; Lupus. 

Antinionimn tart. In toxic doses this drug excites a 
dermatitis, first papular, then vesicular, and lastly pustular, 
and its therapeutic sphere lies in the treatment of pustular 
eruptions, the pustules being large, round, full, with red 
areolae. 

Varieties. Ecthyma; Impetigo erysipelatodes; Syco- 
sis; Acne. 

Apis mel. Indicated in skin affections not going on 
to destruction of tissue, but accompanied by excessive 
itching, especially of a burning, stinging character. Also, 
if there be oedema of the part. 

Varieties. Urticaria; Lichen; Erythema nodosum; 
Lupus. 

Croton tig. Adapted to the treatment of eruptions 
chararterized by the appearance of minute, closely-set, red 
papules, which gradually become vesicles and pustules, 
which break, become confluent, and form scabs, the process 
being accompanied by intense burning and itching. In 
relieving the itching of eczema it often has a magic effect. 

Varieties. Eczema rubrum, faciei et genitale. 

Graphites. Skin affections .characterized by rhagades, 
fissures, excoriations in folds of the skin, and the exudation 
of a sticky, glutinous, transparent fluid from raw places or 
sores. Itching eruptions, secreting a corrosive serum. 

Varieties. Eczema impetiginodes; Mentagra; Impet- 
igo; Psoriasis palmar is; Crusta lactea. 

Lycopodium. Eczematous, suppurating eruptions on 
the head. Eruptions which bleed easily, and form thick 
crusts. Unhealthy skin, with indolent, suppurating inflam- 
mations, and swollen cervical glands. 

Varieties. Impetigo; Porrigo capitis (dry); Intertrigo; 
Plica Polonica; Eczema. _ 



80 



KEY NOTES OF MEDICAL. PRACTICE 



Hepar sulph. Adapted to scrofulous subjects, in •whom 
the slightest injury suppurates. Eruptions moist, inclined 
to ulcerate, exceedingly sensitive to the touch; bleed easily. 
Eruptions spreading by new pimples beyond the main ex- 
coriation. Vesicular or pustular eruptions in flexures of 
joints, elbows, knees, and between scrotum and thighs. 
Abscesses, whitlows, boils. 

Varieties. Eczema impetiginodes ; Crusta lactea; In- 
tertrigo; Impetigo; Herpes labialis. 

Mercurius. Eruption of innumerable, minute, transpa- 
rent vesicles, on a light, rose-colored efflorescence, occupy- 
ing a large portion of the skin, with pricking and itching. 
Itching eruptions, with excoriating discharges. Excessive 
perspiration, viscid, of strong odor, occurring chiefly at 
night. 

Varieties. Intertrigo ; Eczema ; Rupia ; Ecthyma ; Lepra; 
Impetigo ; Psoriasis. 

Mezereum. Eruptions characterized by papulation, 
vesiculation, pustulatiou, and the formation of thick crusts, 
with intolerable itching. Itching occurring in the evening 
when in bed, aggravated or changed to burning by touch or 
by scratching; ' sensitiveness to touch. Ulcers, with red 
areola, sensitive and easily bleeding, painful at night; the 
secretions tend to form an adherent scab, under which pus 
collects. 

Varieties. Eczema,; Impetigo; Herpes zoster; Pity- 
riasis versicolor; Pruritus; Prurigo senilis; Mentagra; 
Erythema. 

Rhus. Vesicular eruptions on any part of the body; 
burning and redness over large cutaneous surfaces, which 
soon swell and become covered with vesicles, accompanied 
by almost intolerable itching and burning. Has a tendency 
to invade large surfaces rather than penetrate deeply into 
tissues. 

Varieties. Eczema; Herpes zoster et labialis; Pem- 
phigus; Erythema nodosum; Urticaria ; Prurigo. 

Sepia. Vesiculo-pustular eruptions, with itching, and 
cracking: of the skin, chiefly affecting the joints, with a yel- 
low, earthy color of the skin, and " liver-spots " in various 
parts. Women with disease of the uterus. 

Varieties. Chloasma; Tinea circinata; Psoriasis; Crusta 
lactea. 

Sulphur. Scrofulous subjects, and those with '"un- 
healthy " skin — every injury suppurates. Papular, vesicu- 
lar and pustular eruptions, with voluptuous itching, in- 
creased by scratching, and by the warmth of the bed. Has 
a wide range of application. 

Varieties. Prurigo; Favus; Impetigo; Acne; Eczema; 
Porrigo capitis; Lichen; Scabies. 



SKIN DISEASES. 



83 



SK i\-i)isnAsrs, 

Acne. Ant. tart., Bell., Hep. s., Kali brom., Kali iod., 
Merc, Puis., Sulph. 

Local. Puncture each pimple with fine point of a lancet, 
encourage bleeding by warm water, then apply hot water 
several times daily, ten minutes at a time. Press out all 
comedos. If indolent, apply stimulating lotion Sulph. 
subl., lij ; Camphor, 3j ; Aqua, ;iv. Mix. To prevent, at- 

tend to diet (avoid fats) and hygiene (wash parts well every 
night with castile-soap and soft water, making friction with 
flannel). 

Alopecia. Ars., Fluor ac, Phos., Phos. ac, Sidph. 

Local. IS TV. Canth., §j; Acid acet.. =jss.; Glycer., §ss; 
Spts. Rosemary, 3 jss.; Aqua Rosa;, ad ?viij. Mix. Apply 
to scalp, and rub in well night and morning. 

Barber's Itch. {Tinea Trycophytina). Shave carefully 
and apply Oint. Merc, precip. rubr. 

Chloasma. Sepia, Sulph., Lye, Guar. 

Comedo. Baryta c, Bell., Xit. ac., Sulph. 

Local. Press out " grub;" shampoo face, follow by fric- 
tion with flannel. Apply lotion of Bora. r and water. Treat 
dyspepsia, amenorrhaea. leucorrhcea, or other attendant dis- 
order. 

Ecthyma. Ant. tart, Ars., Lack.. Merc. Juglans. 

Local. Remove scabs and treat local sores with Calen- 
dula lotion. Correct cachexia by diet, air and baths. 

Eczema. Crot. tig., Rhus, Canth., Graph., Ars., Merc, 
Hep. s., Lye, Mez., Sulph. 

Local. Early stages, soothing lotions. Itching may be 
allayed by lotion of Croton or Rhus. To protect surface 
from air, use — Ij}. Oxide of Zinc, "Ay, Calamine powder., 
|ss.; Glycerine, 31 j ; Rose-water, 3viij. Mix. In chronic, 
wash with mild soap, to remove scabs, then anoint with 
Cosmoline, twice daily. In eczema of hands, with acute 
inflammation, soak every night in weak solution Soda' bi- 
carb., in water hot as can be borne, 10 or 20 minutes. 
Then anoint with Ol. Olivce, Aqua calcis, part, acq., Bism. 
Subnit., Ij. Mix. If itching severe, add Acid mur., dil., 3j- 
Apply on soft muslin and cover with oil-silk. Eczema Im- 
petiginod.es: — Use ointment powdered Graphites and Vase- 
line. 

Erythema. Aeon., Apis, Bell., Mez., Rhus. 

Erythema nodosum. Am., Apis, Rhus. 

Herpes. H. Labial is: — Rhus, Nat. mur., Merc, Hep. s. 
H. Circinatus: — Tell. H. Zoster (Shingles):— Ars., Rhus, 
Mezereum. 

Local. H. Zoster. Protect from irritation. Anoint 
with Vaseline, dredge freely with flour and cover with a 
layer of cotton-wool. 



82 



KEY NOTES OE MEDICAL PRACTICE. 



Intertrigo. Cham., Calc. c, Hep. s., Merc, Sulph. 

Local. Keep parts clean and dry. Anoint with Hydras- 
tis and Vaseline. Dust with equal parts Oxide of Zinc and 
Lycopodium seeds. Boracic acid and Vaseline, very effica- 
cious to allay itching. 

Lichen. Sulph., Ant. c, Apis, Ledum. 

Local. Frequent alkaline baths. Soothing applications 
to allay itching. Improve general health. 

Pemphigus. Rhus, Ars. 

Pityriasis. Ars., Canth., Graph., Mez. 

Local. Frequent baths, with hard rubbing. Apply — ty. 
Borax, ~y, Glycerine, 5j; Rose-water, to 3 viij. Mix. 

Prurigo. Ars., Mez., Rhus, Sulph. 

Local. Use daily cold bathing. Avoid stimulants, in 
drink or diet. Avoid scratching. Apply cold compress of 
Mezereum lotion. 

Pruritus. Calad., Arid nit., Collins., I/ycop., Mez. 

Local. Treat primary condition on which it depends. 
Relief may sometimes be obtained from use of grain 
doses of Chloral Hydrate. Hamamelis lotion to part, 
or anodyne lotions. R). Opium, grs. viij; Kreasote, gtt. x; 
Vaseline, ;ij. Mix. Camphor, 3j; Borax, 3ij; Alcohol, 

?jss; Rose-water, to ?vii j. Mix. 

Psoriasis. Ars., Graph., Merc, Sepia, Sulph. 

Local. Soften scales by applying wet compress, covered 
with oiled silk; when sufficiently macerated, remove patches 
and apply 1$. Red precipitate, finely powdered-, white pre- 
cipitate, act, grs. v.; Vaseline, §j. Mix. 

Tinea Versicolor. First wash well with soap, then 
apply Hyposulphite of soda 3vj; Rose-water, §vj. Mix. 
TMienthal. 

Urticaria. Ant. cr., Apis, Ars., Dulc, Rhus, Urt. urens. 
"Of late I have found Chloral, in gr>iin doses, sufficient." Hughes. 

Local. Warm bath often rapidly curative. To allay 
itching — Grindelia lotion. Or, warm water acidulated with 

Acetic Acid. 



DISEASES OF THE EYE. 

HORDEOLUM. 

REMEDIES. Puis., Merc, Hep. s., Staph., Sulph. 
Local. Hot compresses. Open abscess when it points. 
Local application of Iodine, early, will sometimes abort. 



GONOR11HCEAL OPHTHALMIA. 



BLEPHARITIS MARGINAL! s. 

REMEDIES. Merc, Ars., Graph 1 ., Calc. c, Hepar s 
Puis., Sil., Sulph. 

Local. Remove exciting cause. Soak crusts with solu- 
tion Soda bicarb., grs. x to ?j water. Rest eyes. Avoid 
irritating atmosphere. Observe strict cleanliness. Unguents : 
R>. White precipitate (Hydrarg.-Ammon.-Chlor.) gr. ss to 
Vaseline 3j. Red precipitate (Hijdrarrj.-Oxid.-rubr.) 

grs. ij, to Vaseline 3j, for severe cases. 



< iATARRH A L ( >PHTHA LMIA . 

(CONJUNCTIVITIS SIMPLEX.) 

REMEDIES. Aeon., Bell., Euphr., Pulp., Sulph., Ars.. 
Graph. 

Local. Cold compresses. Borax solution (grs. viii to 
f zi water) ; or, Boracic acid (grs. v. to f 3 j water), a few drops 
in eye three times a day. 

PURULENT CONJUNCTIVITIS. 

REMEDIES. Aeon., Arg. nit, Puis.. Apis m.. Calc. e., 
Calc. jjhos., Hepar s., Merc, Sulph. 

Local. Cold compresses. Keep eye clear of discharge. 

OPHTHALMIA NEONATORUM . 

REMEDIES. Arg. nit, Puis., Hepar s., Alar., Apis m. 

Local. Cleanliness. Constant removal of the discharge 
every 5, 10, or 15 minutes day and night, until discharge 
lessens, then not so frequently. Brush everted lids with 
Arg. nit. solution (gr. j to f Jj). If cornea becomes affected. 
Atropine solution (gr. ^5 to f water), a drop in eye every 
three hours. 

<t< >N0RRH(E A L OPHTHALMIA. 

REMEDIES. Arg. nit, Puis., Apis m., Gale phos., 
Hepar s., Merc, Sulph. 

Local. Cold compresses. Ice-bags. Constant removal 
of discharge. Apply Arg. nit. solution (grs. v to x to f f j, 
aqua) once daily. Use Chlorine water (dil. %), or Boracic 
acid (4 per cent.), in cleansing eye. Corneal implication 
requires Atropine or Eserine solution (grs. iv to f 3j aqua). 



S4 



KEY NOTES OF MEDICAL PRACTICE. 



PHLYCTENULAR OPHTHALMIA. 

REMEDIES. Merc, corr., Aurum, Calc. c, Sulph., Rhus, 
Graph., Arsen. 

Local. Shade eyes. Bandage rarely necessary. Severe 
pain may require solution Atropine once or twice daily. 

GRANULAB LIDS. 

REMEDIES. Aeon., Euphr., Arsen., Merc, iod., Bell. 

Local. Cold applications. Ice bags. Sulphate-of-Copper 
or Alum to granulations. Tannic acid, grs. x. to Glyc. §j, 
applied by camel's-hair brush to thickened conjunctiva; or, 
solution Ary. nit. (grs. v. to f ?j aqua). Where cornea in- 
volved and pain, Atropine solution m.iy be useful. 

KERATITIS. 

Diffuse. Apis, Ars., Aurum, Baryta iod., Hep. s., Merc., 
Sulph. 

Local. Atropine solution (grs. ij to f 5j aqua) if much 
pain. 

Phlyctenular. Ars., Graph., Calc. c, Merc, Euphr.. 
Hep. sulph. 

Local. Smoke-colored glasses. Cleanliness. Yellow- 
oxide-of -Mercury, grs. ij to 3j Vaseline, a piece the size of a 
millet-seed between the lids, once a day. 

Suppurative. Merc., Sulph., Hep. s., Calc. jihos. 

Local. Hot applications, applied 15 minutes, then off 
half an hour, then again applied. Atropine solution; some- 
times Eserine solution. 

Ulcerative. Hep. s., Calc. phos., Merc, Ars., Sulph. 
Local. Bandage. Atropine solution if ulcer central; 
Eserine when ulcer is peripheral. 

IRITIS. 

Serous. Gels., Bry., Kali hyd., Phos. 
Plastic. Merc, sol., Merc, corr., Hepar s., Bell. 
Suppurative. Hepar s., Merc, sol., Silica, Sulph. 
Syphilitic. Kali hyd., Merc corr., Asafoet., Aurum, 
Nit. acid. 

Local. Hot, dry applications. Atropine solution (grs. 
iv to §j aqua) gtt. j. every 3 or 4 hours. Keep the eye 
and that side of head warm. 

GLAUCOMA. 

REMEDIES. Coloc, Ars., Gels., Bell., Bry., Phos. 

Local. Iridectomy. Eserine sulphate (grs. i j to f ? j aqua), 
a drop every 2 to 3 hours, to contract pupil. Complete 
rest of eyes during attacks. 



OTALGIA— ERYSIPELAS. 



86 



DISEASES OF THE EAR. 
OTALGIA. 

REMEDIES. Aran.. Bell., Puis., Ars., Merc. 

Local. Hot. dry applications. Aconite tincture in hot 
water, instilled into ear. Morphine or Atropine (gr. j to f ?j) 
in hot water, and three or four drops in ear. (All these 
solutions are very dangerous if there is any perforation of 
the drumhead.) 

ACUTE INFLAMMATION OF MIDDLE EAR. 

REMEDIES. Aeon,, Puis., Bell., Merc., Hepar s. 

Local. Warm applications. Warm Olive oil and Laud- 
anum, equal parts. Hot water (110 F.) introduced by a 
medicine-dropper, or from a small sponge. Open Eusta- 
chian tube with air-big. Puncture drumhead if bulging. 
Avoid poulticing. 

SUPPURATIVE INFLAMMATION OF MIDDLE EAR. 

(OTORRHCEA.) 

REMEDIES. Silica, Sulph., Calc.-c, Arsen. 

Local. Cleanse ear with absorbent cotton on wooden 
tooth-pick, and apply Boracie acid pulv. If necessary 
syringe ear with warm water and Carbolic acid (gtt. x to 
f §i j aqua) or Boracie acid solution (grs. x to f §j aqua), 
and dry ear with absorbent-cotton afterwards. Mastoid 
complication — Incision over mastoid process, one inch long 
and about % inch from, and parallel to, auricle. 



CONSTITUTIONAL DISEASES. 
ERYSIPELAS. 

Prognosis. Generally favorable. Unfavorable in the 
aged; in drunkards; if gangrenous; if thrombosis occurs; 
extension to larynx; high degree of blood-poisoning; phleg- 
monous variety; metastasis to brain. 

LEADIXG REMEDIES. 

Belladonna. Smooth, bright, shining red skin; conges- 
tion of head, with throbbing carotids. Intense fever; tend- 
ency to attack brain; delirium. 

f< -j- he rem edy so lorn? as color is bright-red, and fever high." Hxtghex. 



86 KEY NOTES OF MEDICAL PRACTICE. 

Apis. Burning, stinging pain in affected part;^ skin 
pale; oedematous swelling, dryness of throat. CEdema 
glottidis. 

Rhus t. Vesicular erysipelas; dark, bluish redness of 
affected part, with burning and itching. 

SPECIAL REMEDIES. 

Graph. Wandering erysipelas. 

Canth. Vesicular. From Arnica. 

Lyc, Hep. s. Local, without fever. 

Strain., Kims. Secondary meningitis. 

Aeon. Fever. Phlegmonous erysipelas. 

Lach. Dark purple, threatened gangrene. 

Hep. S. Phlegmonous, to promote suppuration. 

Arsen. Typhoid condition; disorganization of blood. 

Graph.. Sulph. To complete cure, and remove swelling, 

GENERAL MEASURES. The best local treatment is 
application of cloths moistened in tepid water, containing 
Verat. vir., tinct., a drachm to two ounces of water. As soon 
as evidence of suppuration in subcutaneous cellular tissue, 
make long and free incisions through the skin. After 
incising, apply poultice, and provide for thorough drainage J 
and escape of pus. Do not expose skin to variations of J 
temperature. Do not paint with collodion, unless inflam- 
mation of very limited extent. Dry flour or powdered I 
starch dusted over will allay suffering from heat and pain. 
Give plenty of pure air. 

Diet. Keep up strength by nourishing food, milk, 
broths, beef-essence. Cool drinks to slake thirst. 

A.CUTE ARTICULAR RHEUMATISM. 

SYNONYM: Rheumatic Ferer. 

Prognosis. Seldom fatal. Unfavorable: — Delirium and 
coma; scanty excretion of solids in urine; previously-exist- 
ing heart-disease. 

LEADING REMEDIES. 

Aconite. Intense febrile movement, pulse full and 
strong, great thirst, anxiety and restlessness; especially for 
inflammation of large joints, which are red, swollen, and 
exceedingly sensitive to contact. 

"No remedy more adapted to rheumatism." Hempel. 

Bryonia. Fever of adynamic form: the articular swell- ' 
ing pale, or dark red, and exceedingly painful, aggravated 
by contact or the slightest motion. Follows well after 
Aconite. 

" A leading remedy for acute and chronic." Baehv. 



KHEUMATISM. 



87 



Rhus. Adynamic fever, great restlessness, parts red 
and swollen, pains drawing, tearing, burning; feels worse 
when at rest, better on continued motion. Especially lower 
extremities, and when brought on by getting wet. 

"Occupies a high place among the remedies for rheumatism." Hughes. 

Mercurins. High fever, quick, hard pulse; obstinate in- 
liammation of a single joint; puffy swelling, pale or light 
red; tearing, burning pains, deep-seated, as if periosteum 
affected, much worse at night; sour perspiration, without 
relief. Breath foul, tongue with thick, yellow coating, ap- 
petite gone. Very sensitive to cold. 

Pulsatilla. Sub-acute cases, with little fever, the pains 
shifting frequently from part to part; pains violent, draw- 
ing and jerking. Not much redness or swelling. Chilliness. 

" In subacute rheumatism, extremely useful." Hughes. 

SPECIAL. RE II ED IKS. 

Sulphur. Chronic rheumatism. 

" Invaluable to prevent the lingering of convalescence, or the pass- 
ing of the disease into a chronic form." Hughes. 

Caulophylhim. Rheumatism of wrists and finger- joints, 
and of small joints. 

Actea. Articular rheumatism of lower extremities; 
severe attack; sudden onset. 

Viola odorata. Rheumatism of wrists in persons of 
highly nervous organization. 

Belladonna. Red, shining swelling. Frequent doses at 
night for insomnia. 

Chin.. Sulph. Acute articular; fever of remittent type. 

Spigelia. Carditis of rheumatic fever. 

CHRONIC RHEUMATISM. — Bry., Rhus, Rhod., Led., 
Puis.. Dulc, Sulph., Merc, Kali hyd., Kali bi. 

GENERAL MEASURES. Rest and warmth are the 
cardinal principles in the treatment of rheumatism. Keep 
the patient quiet, in a warm bed and covered with soft 
blankets. Do not let a draft of air strike him, or let him 
get the slightest chill. Cover affected joints with raw cot- 
ton, keeping it on for days. Use no baths if skin acts 
freely; if, however, skin hot and dry, give patient hot pack. 
Examine the heart at every visit. If pain excessive, great 
relief will follow use of 

R. Carbonate of potash, - § j; 

Tr. Opium, - - - 3 vi; 

Warm water, - - - - O j. 

Mix. 

Apply locally by a soft cloth, and cover with dry cotton. 

" I have seen so much relief follow its use that I should be sorry to 
deprive a sufferer of it." Hughes. 

Diet. The use of beer, ale, wine, brandy, and all malt 
or spirituous liquors, must be strictly prohibited. Use no 
sweets. Lemonade is harmless. 



88 



KEY NOTES OF MEDICAL PRACTICE. 



DROPSY. 

Arsenicum. Great debility and prostration, anxiety, 
restlessness, emaciation, dyspnoea, burning thirst, oedema 
of face, hands and feet, and anasarca from disease of heart. 

" Suitable in all forms of dropsy, more particularly that depending 
on heart-disease, and oedema of the lungs." Baehr. 

Apis. Acute febrile dropsy: dropsy complicated with 
strangury, suppression, or other urinary disorder. Unab- 
sorbed effusions after serous inflammation. Post-scarla- 
tinal dropsy. Absence of thirst and suddenness of cedema 
indicate this remedy. 

Apoc. Can. Restores urinary secretion. Urine scanty, 
thick, yellow and turbid. Has cured hydrocephalus super- 
vening on typhoid, and anasarca, hydrothorax and ascites. 
(Of no use in hydrocephalus from tubercular meningitis, 
or ascites from cirrhosis of liver.) Dose: — one to five 
drops of mother-tincture, or drachm doses of infusion of 
fresh root, an ounce to a quart of water. 

" Has made many brilliant cures." Hale. 

Digitalis. Small, feeble, irregular pulse, pale face, livid 
lips, distressing dyspnoea. 

" Especially for cardiac dropsy. Must give large doses." Hughes. 

" Valuable in almost every variety; often succeeds in most desperate 
cases." Ruddock. 

Bryonia. (Edematous swelling of joints. Hydrothorax. 
Dropsy associated with chest symptoms — cough, dyspnoea, 
stitching pains in region of heart; disease of liver. 

Helleborus. Urine scanty, dark-colored, depositing sedi- 
ment like coffee-grounds. Useful in hydrocephalus, hydro- 
thorax, anasarca, and dropsies following scarlet and inter- 
mittent fevers. 

Senecio. Abdomen very tense, feet and legs swollen, 
urine scanty and high-colored, or, profuse aud watery. 
With liver symptoms, from peritonitis, or abdominal tumors. 

China. Dropsy from exhausting discharges. General 
debility, countenance pale or sallow; organic affections of 
liver or spleen. 

Aconite. Recent febrile dropsies. 

Ferrunt. Anemic or chlorotic females. 

Sulph. (Edematous swellings following skin affections 
or suppressed eruptions. 

General Dropsy. Dig., Apis. Ars., Bry., Apoc.. Senega. 
DROPSY OF 

Heart. Dig., Spig., Ars. 

Chest. Bry., Dig., Ars.. Hell. 

Joints. Aeon., Puis., Bry., lod. 

Ankles. Ferr., Bry., Chi., Ars. ■ 

Brain. Hell., Apis., Merc., Bry. 

Abdomen. Apoc, Ars., Chin., Crot. 

Scrotum. Iod., Rhod., Puis., Graph. 

Dose ^"Dropsy requires to be treated with larger doses than almost 
any other disease." Baehr. 



DIPHTHEBIA. 



89 



GENERAL MEASURES. If abdomen be so distended 
as to seriously embarrass respiration and heart's action, 
evacuate with trocar and canula, or aspirator. Introduce 
in mesian line, midway between navel and pubes. Draw a 
sheet around abdomen, and tighten it as fluid is gradually 
withdrawn. If legs are much swollen, the skin tense, make 
incision three-quarters of an inch long over each malleolus. 
Keep warm sponge, moistened in weak Carbolic acid solu- 
tion, to each incision. 

Dl6t. Give all the water that patient wants^large quan- 
tities of soft water beneficial. In renal dropsy a systematic 
course of skim-milk diet has proved beneficial. The pa- 
tient should be well nourished, receiving a liberal quantity 
of nutritious, digestible food. 

Hygiene. Warm baths and vapor-baths useful in pro- 
moting perspiration. The clothing should be warm, and 
the abode high and dry. 

DIPHTHERIA. 

PROGNOSIS. Grave. Unfavorable:— Exudation dark, 
thick, extensive; extension to larynx or posterior nares; 
great fetor of breath; early pharyngeal paralysis; slow and 
intermittent pulse; persistent vomiting; epistaxis; great 
glandular swelling. The younger the child, the more unfa- 
vorable. Favorable: — Affected surface small. So long 
as exudation confines itself to fauces and anterior pillars 
of pharynx, and is not thick or putrid, prognosis favorable. 

IiEADUTG REMEDIES. 
Belladonna. Mild cases. Great dryness and redness of 
throat, with high, fever. 

Suitable only in the beginning." Raue. 

Phytolacca. Throat dry and swollen, difficult deglutition, 
exudation grayish-white, great prostration, high fever, vio- 
lent aching in back and limbs. 

"Acts in truly specific manner." Hughes. "My experience has 
been very favorable, giving it in one or two drops of the tincture." Bayes. 

Apis lliel. Great prostration from beginning, great 
oedema of Ihroat and tonsils, surface glossy, and of purp- 
lish color, burning pain and dryness of throat, extending 
into ears, dirty-gray exudation, high fever, cedematous 
swelling of face and neck. 

"I have seen striking results from it, and can commend it highly." 
Hughes. 

Kali bi. Croupy cough, preceded by wheezing and pant- 
ing, pain in chest, uneasiness in stomach, nausea, fauces 
covered with dirty-yellow exudation, which is tough, stringy 
and tenacious; discharge from nostrils of yellow, corrosive 
mucus. 

" In nasal diphtheria I find it specific; in laryngeal, it does all that 
medicine can do." Hughes. 



90 



KEY NOTES OF MEDICAL PRACTICE. 



Bromine. Laryngeal diphtheria, the exudation begin- 
ning in larynx, or beginning in fauces and extending to 
larynx. Suffocating cough, with hoarse, whistling, croupy 
sound. 

31ero. iod. Great swelling of parotid and submaxillary 
glands, tonsils much swollen, putrid sore throat. Cases 
marked by great putridity, with dirty coating on tongue, 
and foetid breath. 

Laohesis. Small amount of exudation, throat purple, or 
livid, prostration very great, with weak pulse, cold, clammy 
perspiration. 

Merc. cyan. Malignant diphtheria; the disease comes 
on suddenly, develops quickly, and patient is rapidly pros- 
trated. Putrid sore throat, the exudation dark-gray, thick 
and putrid, occupying whole throat, and extending to 
nasal fossae. 

Muriat. ac. Exudation gray, breath foul, lips dry. 
blackish and cracked, tongue dry. the membrane begins to 
invade the larynx and nose, from which there is a darkish, 
fetid discharge; extremities cold, pulse weak and compres- 
sible, general prostration. 

"It has some efficacy when symptoms of blood-poisoning are \ 
present." Hughes. 

Kali perman. Breath very foul, general and excessive 
prostration, foul exudation over fauces, with extension into 
nasal fossa;, with thin, excoriating discharge from the nose. ! 
Septic forms. 

Cantharis. Excessive pain on swallowing; throat looks 
as if blistered, expectoration of blood, extreme prostration; 
sinking turns. Cold extremities. Scanty urine, with albu- 
minuria. 

" It has served me well." Hughes. 

<«\H<.LI,S AM> SPRAYS. 

Alcohol. Diluted with three parts water. Use as I 
gargle ; 

Kali perman. Grs. iv. to aqua fviij. Use as gargle when 
exudation is putrid, breath foul, or thin discharge from nose. 
Liquor calc. chlor. Use in atomizer as spray to throat. 
" Of virtue in the most malignant cases." Neidhard. 

GENERAL MEASURES. Quarantine patient, if pos- 
sible, in a light, airy, upper room. Send other children 
from the house. Keep sick-room well rent Hated. Tempera- 
ture 70°. Throw all soiled rags into the fire: disinfect all 
soiled linen. Do not inhale patient's breath, or let a piece 
of the membrane come in contact with a mucous or abraded 
surface. 

Absolute rest iu recumbent posture necessary. Early in 
disease let patient take bits of ice in mouth. Later use 
steam atomizer, and at frequent and regular intervals let 



ASIATIC CHOLERA. 



HI 



patient inhale the vapor. If secretions are putrid, the anti- 
septic gargles and sprays must be used at frequent intervals 
in order to be of benefit. Keep nasal cavities clean. Put 
Chlorine-water into the spray-cup of atomizer. In con- 
valescence, danger of paralysis of heart on over-exertion. 
Patient should not attempt to swallow solid food till muscles 
of pharynx fully restored. In adynamic cases do not use 
cold drinks or cold applications. 

Diet. Highly important to keep patient well nourished. 
Begin early. Give to patient all the milk that he can be 
induced to take — iced, boiled, warm from cow, or in any 
way to suit his fancy. Occasionally give a glass of milk 
with a beaten-egg in it. Beef-tea and coffee better as stimu- 
lants than alcohol. Make a cup of strong coffee, add 
scalded milk one-half; sweeten to taste; beat yolk and 
white of an egg together, pour the hot coffee and milk over 
them, and serve. This is very nourishing and stimulating. 
If patient cannot swallow food, must be nourished by ene- 
mata. Give plenty of water to slake thirst. Ice-cream 
and water-ices may be given freely, only taking care not to 
chill the stomach. 

ASIATIC CHOLERA. 

SYNONYMS: Serous Cholera; Malignant Cholera. 

PROGNOSIS. Always grave. Varies, however, accord- 
ing to the period of the epidemic, as it is most deadly at 
the commencement of an epidemic, whereas those occurring 
later in its course are more apt to be followed by recovery. 

COMPLICATIONS. Suppression of urine; gastritis and 
enteritis; pulmonary congestion; meningitis; sloughing of 
the cornea; abscesses over the body; coagula in right 
heart or pulmonary arteries; haemorrhage of bowels. 

LEJLDflVGi REMEDIES. 

Camphor. Early in the attack. Patient suddenly loses 
strength, and looks pinched and blue; the skin becomes 
very cold, the voice deep and husky; the skin shrivels. 
Intense distress and anguish at pit of stomach and burning 
in the bowels, the patient tossing in agony; sometimes 
nausea and vomiting, but generally the evacuations both 
up and down are moderate and infrequent. Dose: — "Give 
the patient three to five drops of the tincture, on a little 
sugar, every five minutes, and in the intervals assiduously 
rub him on the neck, chest, and abdomen with the same 
medicine, until the icy coldness of the body gives place to 
a return of vital warmth." Hahnemann. 

" It is our firm belief that Camphor is an almost infallible remedy if 
given from the very onset." Dr. Russell. " Very few of the cases went 
into collapse when Camphor was given in the first stage." Dr. Proctor. 



92 



KEY NOTES OF MEDICAL PRACTICE. 



Verat. alb. Cases marked by 'excessive vomiting and 
purging, with violent abdominal pains. Especially indicated 
when attack commences with vomiting and purging. Pale 
and sunken countenance; hollow eyes, with blue margins; 
repeated and violent vomiting, with frequent, copious, 
watery, rice-water evacuations. Violent colic, especially 
about the umbilicus. Dose: — "Almost all observers agree 
in recommending the lower preparations, even the strong 
tinctures, frequently repeated." Baehr. 

Arsenicum. Sudden and extreme prostration, vanishing 
of the pulse, great dyspnoea, inexpressible anguish, con- 
stant tossing about, violent thirst, yet the least quantity of 
liquid is thrown up immediately; burning distress in region 
of stomach, complete suppression of urine. 
" The medicine most trusted in collapse." Hughes. 

Cuprum acet. Loss of consciousness, spasmodic cramps 
of fingers and toes, audible gurgling of liquids down the 
oesophagus, ineffectual efforts to vomit, the diarrhoea has 
ceased, but loud gurgling in bowels, indicating paralysis 
of intestines. Symptoms indicating general paralysis of 
organism. Also recommended as prophylactic. Give doses 
of the remedies at frequent intervals. 

SPECIAL KEMEIUES. 

Hydroc. acid. Pulselessness, respiration slow, deep, 
gasping, taking place at long intervals. 

"It would seem at times to restore animation to a corpse." Dr. 
Russell. 

Secale, Phos. Profuse, watery stools, after violence of 
attack is past. 

Phos. ac. Rhus. Supervening typhoid condition. 

Tereb.. Canth. For continued suppression of urine, if 
Ars. fail. 

GENERAL MEASURES. Place patient immediately 
in warm bed. Keep him at perfect rest on his back, and 
surround him with hot bottles. Make friction with warm 
flannels. The room should be warm, but well-ventilated. 
No food can be taken. Enemata of warm milk, even though 
rejected, are beneficial. 

Use antiseptic precautions in disposing of discharges 
and of soiled linen, as directed in Typhoid Fever, p. 7. 

CONVALESCENCE. A return to ordinary diet must be 
gradual, as an attack of indigestion may excite relapse. 
Give no solid food till stools are consistent and fecal. Be- 
gin with milk, thin gruels, chicken-broth, and digestible, 
liquid food. 

PRECAUTIONS. Close all surface-wells and those in 
vicinity of drains and cesspools. Remove all filth, and use 
disinfectants freely. Corpses should be immediately placed 



CHOLERA INFANTUM'. 



98 



in coffin containing mixture of lime, charcoal and carbolic 
acid, and at once disposed of by burial or cremation. In 
cholera season direct your patients to observe regular 
habits in all things. All drinking-water must be boiled 
and filtered. Give strict attention to the first appearance 
of a diarrhoea. 

CHOLERA INFANTUM. 

PROGNOSIS. Uncertain. Favorable: — Cessation of 
vomiting: diminution in frequency and quantity of dis- 
charges; quiet, natural sleep; even temperature of body 
and limbs; diminution of thirst; returning appetite. 

Unfavorable: — Extreme restlessness and jactitation, or, 
early apathy, stupor, or convulsions; incessant and obsti- 
nate vomiting; excessive frequency and copiousness of 
stools: Hippocratic countenance; extremities cold. blue and 
shrunken. To detect earliest loss of flesh, examine inside 
the thighs. 

LEADIXG KJ.III IMI N. 

Verat. alb. Vomiting and purging, the latter predom- 
inating. After vomiting or purging, great exhaustion, cold 
sweat on forehead. Severe colic. Stools profuse and 
watery. 

" A remedy of great value, and one very often required." Bell. 
" The chief remedy." Jousset. 

Ipec. Vomiting, and almost constant nausea. Stools 
grass-green, or white, with fermented appearance, like 
yeast. Colic and sick stomach before and during stool. 

" Verat alb. and Ipec. are undoubtedly the most important of all rem- 
edies." Raue. 

Arsen. Great prostration, extreme restlessness and un- 
quenchable thirst. Cold extremities, face pale and cada- 
veric, skin dry and shrivelled. Stools thick, dark-green, or 
dark, watery, offensive. 

" The symptoms which most clearly distinguish it are the character- 
istic thirst and restlessness." Bell. 

Croton tig". Yellow, watery stool. Aggravation from food 
and drink. Stools expelled suddenly and with great force. 

"Its proper application will render success certain and brilliant." 
Bell. 

Podopll. Gagging and empty retching, without vomit- 
ing. Moaning, with half-closed eyes and rolling head from 
side to side. Stools profuse, painless, watery, with meal- 
like sediment. 

" Ranks among the first to be referred to." Bell. 

Merc. Dark-green stools, slimy or bloody, frequent, ex- 
coriating and scanty, with tenesmus, and colicky pains. 
Tongue coated, swollen, soft and flabby. 

Camphor. Attack very sudden. Great and rapid sink- 
ing. Child in stupor, utter prostration, face pale, livid, 
purple, icy cold. Vomiting and purging sometimes absent. 



94 



KEY NOTES OF MEDICAL PRACTICE. 



/Etlnisa. Child lies in an unconscious state. Grave 
symptoms — thumbs clenched, eyes fixed and staring, pupils ) 
dilated, great prostration, continual gagging, great fre- 
quency of stools. Symptoms of hydrocephaloid. 

" Suitable to a severe form of cholera infantum." Bell. 

Aconite. Early in attack, with hot skin, quick pulse, 
thirst, restlessness, high fever. Stools green, watery, with | 
cutting pain and tenesmus. 

" Only useful in very beginning." Bell. 

Belladonna. Hot head, flushed face, cold feet, great dry- 
ness of mouth and lips, great drowsiness, with sudden start- 
ing during sleep. Stools green. 

Calc. carl). Sour vomiting, open fontanelles, old-look- ' 
ing, wrinkled face. Profuse sweat on head during sleep, 
cold extremities, emaciation, bloated abdomen. Stools 
whitish, watery. 

" The stools of less importance than the person and concomitant 
symptoms." Bell. 

Apis mel. Tongue dry and shining. No thirst. Skin 
hot and dry. Stools greenish, yellowish, slimy mucus. Ab- 
domen tender to pressure. Symptoms of hydrocephaloid: — 
Stupor, interrupted by shrill cries, head hot, eyes red, hands 
cold and blue, abdomen tender, sunken, urine suppressed. 

" One of our most precious remedies, corresponding to a low and 
dangerous condition." Bell. 

GENERAL MEASURES. Keep the child in a cool. : 
shaded place, and let it have an abundance of fresh air. 
Avoid close, ill-ventilated apartments. No matter how sick 
it may be, take it riding, or, if possible, boating on the 
water. Cool, fresh, pure, air necessary to recovery. Give 
it frequent, cool sponge-baths, or full baths, putting it 
into water at 85% and gradually cooling it down to 75 F. 

Diet. Of highest importance. If child cannot nurse at 
the breast, its food should consist of fresh, pure, milk, di- 
luted with barley-water and lime-water. {Vide Article 
" Infant Diet.") If there be great debility and prostration, 
give beef-tea, or wine-whey. Use no starchy foods what- 
ever. If sufficient food cannot be taken by stomach, use 
inunctions of oil to abdomen and extremities. If water be 
rejected from stomach, baths will supply fluid for the 
blood, and bits of ice slake thirst. Absolute cleanliness of 
bottle, and absolute purity of milk and other food, will 
accomplish all that can be in this direction. 

DIABETES MELLITUS. 
Phosphoric acid. Frequent urging to urinate, pain in 
the loins, emaciation and prostration. Particularly valua- 
ble in cases of nervous origin. Dose:--1x diluted, several 
times a day. 

"Stands in the highest place among the remedies for diabetes " I 
Hugh ex. 



LITIOSMIA. 



95 



Uranium nitrate. "Cases originating in dyspepsia or 
assimilative derangements. Excessive thirst." Dosk: — "The 
practitioners who have employed it, have generally given 
strong and increasing doses of the first-decimal tritura- 
tion." Hughes. 

Arsenicum. Insatiable hunger, unquenchable thirst, 
pale skin, loss of strength, dryness of mouth and throat, 
excessive urination; watery diarrhoea. 

CONSULT — Helonin, Kreasot.e, Plumbum, Argentum nit. 

Diet. Must be free from starch and sugar. Exclusive 
milk-diet often benefits. Gluten bread must be substituted 
for that made of white flour. 

Avoid. Vegetables. — Arrow-root, asparagus, bread, bis- 
cuit, beans, beets, crackers, carrots, maccaroni, oat-meal, 
pastry, potatoes, peas, rice, sago, sugar, turnips, tapioca, 
vermicelli. 

Fruit. — Apples, grapes, pears, bananas, peaches, plums, 
pineapples, raspberries, and other sweet fruits. 

Beverages. — Wine, beer, brandy, ale, cider, and all alco- 
holic and sweet drinks. 

Allowable. Vegetables. — Artichokes, cabbage, celery, 
cresses, cucumbers, olives, greens, lettuce, pickles, spinach, 
mushrooms. 

Fruits. — Lemons, cherries ( sour), currants, gooseberries, 
strawberries, and acid fruits generally. 

Meats. — Beef, mutton, poultry, game, fish, oysters, cheese, 
eggs, etc. 

Gratify the thirst by an abundance of soft water. 

GENERAL MEASURES. The diabetic should be 
warmly clad in flannels, and avoid cold winds, and expos- 
ure of all kinds. 

LITH.EMIA. 

SYNONYMS: Lithiasis; Uric-acid Diathesis. 

CAUSES. Over-indulgence in stimulants, or rich, nitro- 
genized food, with sedentary life. 

REMEDIES. Plumbum, Nux i>., Lyeopodium, Sepia, 
Sulphur, Hepar s., Calcarea c.. Podophyllum, Hydrastis, 
Arsenicum, Nitro-muriatic acid. 

Regimen. Active out-door exercise! Daily salt-water 
sponge-bath. Keep warmly clad, and avoid chill. 

Diet. Highly important. Avoid meats, oysters, eggs. 
Adopt mixed vegetable diet. Celery said to be especially 
beneficial. Use no stimulants — wines, brandy, ale or beer. 
Use no pastries, sweets, or anything which will cause indi- 
gestion. Avoid late dinners and late suppers. Eat slowly, 
and masticate thoroughly. Drink an abundance of pure, 
soft water. Vichy water has cured. 



KEY NOTES OF MEDICAL PRACTICE. 



PART II. 



OBSTETRICS. 



ABOETTON. 

LEADIXG REMEDIES. 

Sabina. Threatened abortion in the early months of 
pregnancy. Sensation of heat and soreness in the womb, 
with drawing pain from the back through to the pubes. 
Sometimes succeeds even if pains and a red discharge 
have set in. 

" One of the best remedies we have to prevent abortion." Guernsey. 

Secale. Threatened abortion in the later months. Even 
when decided hasmorrhage is present, ten-drop doses of 
tincture every three or four hours check it, pregnancy 
going on to full term. Copious flow of black, liquid blood, 
worse from slightest motion. 

" Secale and Sabina most in repute for correction of the habit of 
abortion." Hughes. 

Actea, Rheumatic subjects. Irritable uterus. Com- 
plains much with even slight pains. 

" Has been successfully used to prevent habitual abortion." Hale. 

Caulopliyllum. Severe pains in back and loins; uterine 
contractions feeble, slight flow. 

Viburnum. Given before membranes are injured, when 
pains are spasmodic, often succeeds. 

Arnica. When from fall, blow, or other injury. 

Ipec. Nausea, discharge of bright-red blood, faintness. 

Morph. sulph., by hypodermic injection, when symp- 
toms are urgent, will sometimes succeed when it is too late 
to accomplish anything by other drugs. Dose: One-eighth 
to one-quarter grain. Repeat if necessary. Deodorized 
Tr. Opium, by rectal injection, keeping woman quiet on her 
back for days, sometimes tides over. 

Predisposition to abortion may often be corrected by 
administering the appropriate remedy. Dose, twice daily, 
from cessation of menses until after the period at which 
the accident has before occurred. Apis., Caul., Actea, 
Helonias, Sepia, Sulph,, will be found particularly useful. 



ABORTION. 



97 



GENERAL MEASURES. In subjects of habitual 
abortion, build up general health and strength by generous 
diet, systematic exercise, an abundance of fresh air, and 
regular bathing. All tendency to cough, indigestion, 
diarrhoea or constipation, rheumatism, irritable bladder, 
ovarian disease, or other malady, should be corrected by 
appropriate medication. 

Should miscarriage threaten, direct patient to lie down 
' at once, on a bed having a hard mattress, with light cover- 
ing over her. In this position she must remain at jiafcct 
rest, avoiding all motion, and mental excitement. Keep 
the apartment eool and quiet. Whatever food is taken must 
be plain and unstimulating. such as tapioca, rice, toast or 
milk; beverages should be cold. 

MISCARRIAGE. If the womb lose the fruit of concep- 
tion prior to seventh month, it is called miscarriage — after 
that period. premature labor. The latter is to be treated as 
labor at full term. If sac rupture in early months, liquor 
amnii escapes, and. of course, repair cannot take place, so 
that there will be constant leakage, and abortion is hard to 
prevent; but the threatened catastrophe may be averted by 
long-continued rest. 

Signs. Increasing frequency and severity of pains, 
continued flow, and, especially, protrusion of ovum. 

TREAT3IEXT. Tampon immediately. Never tampon, 
vagina after the seventh month. 

The best tampon consists of pledgets, or small balls, of 
raw cotton, each one tied with a string, one end of which 
should protrude, to facilitate removal. Or, a soft silk or 
cambric handkerchief may be employed, inserting first one 
corner, and gradually stuffing in the entire kerchief. All 
tamjwns should be well oiled before insertion, using car- 
bolized oil. 

Do not leave ta mpon in longer than twelve hours. When 
it is removed, the entire contents of the womb will prob- 
ably be expelled. If not, repeat, first washing out vagina 
with carbolized water. Examine carefully all clots which 
come away, to see if they contain the entire ovum. 

Profuse haemorrhage is to be treated by the tampon, cold, 
and the appropriate drug, or injections of hot water 
(120= F.). 

If a portion of the ovum or placenta remain in the 
uterus, take measures to bring it away without, delay. De- 
press the uterus, with one hand placed above the pubes, and 
attempt its withdrawal with the finger of the other, using 
gentle, yet persistent effort. Failing in this, use the pla- 
cental forceps, or blunt-hook. If the mass be allowed to 
remain, there is danger of secondary haemorrhage, or of 
septicemia. After-treatment, as after labor. 

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PARTURITION— PROLAPSE OF COKD. 



99 



PARTURITION. 

TAKE TO CASE OF LABOR — Forceps, soft-rubber 
catheter, Ergot, Chloroform, Ammonia. For perineor- 
rhapliy — curved needles, silver-wire or silk sutures, blunt- 
pointed scissors. For cruniotom (/—perforator, craniotomy- 
forceps; decapitating hook. 

EXAMINATION. Observe— condition of bladder and 
rectum; vagina, and os and cervix uteri; condition of mem- 
branes; pelvic capacity; determine presentation and 
position. Make out presentation before membranes rup- 
ture. Do not press on membranes during a pain. 

RIGID OS UTERI. Aconite. Os hot, dry and sensi- 
tive, patient feverish and restless. 

Belladonna. Spasmodic rigidity of the muscular fibres 
of the cervix. 

Gfelsemium. Give five to ten drops of Gels, in a cup of 
hot water, in divided doses. 

" It often acts like magic in producing dilatation and promoting 
labor." J. S. Douglas. 

Local. Apply Belladonna cerate. Warm vaginal injec- 
tions. Digital dilatation. 

TOUGH MEMBRANES. Notch the finger-nail like a 
saw, and rub it to and fro on the bag until it gives way. 

TUMEFACTION OF ANTERIOR LIP. In interval of 
pains press tumor up above crown of the head, and keep it 
there during two or three pains, until it is fully retracted. 

CYSTOCELE. Evacuate bladder by means of soft-rub- 
ber, or silver (male ) catheter, or, failing in this, use aspi- 
rator to draw off contents. 

HYMEN. Make crucial incision, if spontaneous rupture 
does not occur. 

RIGID PERINEUM. Apply hot fomentations. 

Ergot. Use of, in labor: — Ergot should be given to 
facilitate labor only if the parts are fully dilated, position 
normal, and head presenting at outlet. 

PROLAPSE OF CORD. 

{Frequency, — 1 in 300 or 400.) 

If there be?io pulsation in cord, do not interfere. Other- 
wise, place patient in knee-chest position, and, if possible, 
reposit cord well into uterus with the hand, or by means of 
a loop of tape attached to the end of a gum-catheter. 
Failing in this, terminate labor quickly as possible by the 
forceps. 



]00 



KEY NOTES OF MEDICAL PRACTICE. 



PLACENTA PREVIA. 

(Frequency, — 1 in 500.) 

Place woman on back, hips elevated, shoulders low, and 
pack the vagina well with the tampon. Do not leave tam- 
pon in longer than ten hours. Attend to bladder. If parts 
dilated or dilatable, and presentation of placenta is com- 
plete, perform podalic version, and terminate labor soon 
as possible. Oil the hand, and pass it between the placenta 
and uterine walls, search for feet, rupture membranes, turn 
and deliver. 

POST-PARTUM HJEMORRHAG E. 

As soon as it is discovered that the woman is " flooding," 
quickly but carefully pass hand into uterus, and turn oat 
all clots, fragments of placenta, etc., clearing the uterus of 
all contents — grasp fundus with other hand (previously 
dipped in cold water, if this can be done without delay), 
and have nurse pour a small quantity of cold water onto 
abdomen from a height of several feet. As quickly as 
possible follow this by passing nozzle of a syringe into 
cavity of uterus, and inject a stream of hot water — 110° to 
115° F. If delay would be too great in providing for hot- 
water injection, use cold water, or, pass a piece of ice into 
uterus. 

As soon as haemorrhage has been sufficiently controlled, 
to guard against recurrence, — lower shoulders and elevat* 
hips; tie bands about the extremities, as near to body as 
•possible (let them be snug, but not too tight) ; put on snug 
binder, with compress over uterus; give indicated remedy— 
Ipec, China, Secale, Sabina, etc., according to indications on 
p. 110. 

If alarming flow persist, compress abdominal aorta to 
left of spine, on line with umbilicus, or, as last resort, 
inject into uterus solution perchloride of iron — two ounces 
to one pint "of water. This — preferably by means of a 
fountain, syringe — should be slowly and gently injected 
through the uterus, previously seeing that it is clear of 
clots. Transfusion often successful in ^restoring the 
woman, when exsanguine. 

VERSION. 

PODALK 1 . Best performed before rupture of mem- 
branes. ()s must be dilated or dilatable. Evacuate bladder 
and rectum. Anaesthetize patient. Bring hips to edge of 
bed. Bare the arm, and anoint arm and hand, except the 



VERSION — FORCEPS DELIVERY. 



101 



palm. Use the band whose palmar surface corresponds to 
face of child. AVork between the pains. With one hand on 
abdomen, introduce other into vagina, pass it on between 
membranes and uterine walls, carefully search for feet, 
rupture membranes, grasp one foot and bring it down, at 
the same time pressing head upward with other hand, to 
aid the turning process. After breech has become engaged, 
labor may be at once terminated, or left to the efforts of 
nature. 

COMBINED METHOD. To be employed when os is 
but slightly dilated. Introduce one or two fingers of one 
hand into os, with other hand on abdomen. Determine 
location of head and breech, and, by combined action of the 
two hands, gradually " work *' the head downward and the 
breech upward, until head is brought to present at the os, 
when membranes should be ruptured. 

When Required. Version is called for in placenta- 
praevia. prolapse of cord, transverse presentation, presenta- 
tion of arm, death of mother, rupture of uterus, convulsions, 
or any state in which speedy delivery is demanded. 

FOECEPS DELIVERY. 

Parts must be dilated or dilatable. Evacuate bowels and 
bladder. Anaesthetize patient, unless the child's head is at 
outlet, when it may not be necessary. Immerse blades in 
warm water. Have woman lying across bed, with hips at 
edge, thighs separated, and held by assistants. Rupture 
membranes, if still intact. Anoint convex surfaces of 
blades with lard or oil. Take position between separated 
limbs of patient. Take male blade into left hand; hold it 
almost upright; pass two fingers of the right hand short 
distance within cervix, on the woman's right side, between 
fcetal head and uterine wall, then introduce point of blade 
along inside of fingers, and pass it, gradually lowering the 
handle, until the convexity of the child's head is well 
grasped by the fenestrated portion of the blade; depress 
handle near to perineum. Now take female blade in right 
hand, and, beginning with blade upright, in similar man- 
ner, but by reversed movements, pass blade in right side of 
vagina and cervix, bring handle down, and lock the two. 
Proceed gently, and use no force. 

Traction. As a rule, make traction only during a 
pain. The direction, if head is high, should be first down- 
wards; but, as head gradually descends, more and more 
upwards, until just before the head escapes from the vulva, 
when traction is almost at right angles with the long axis 
of the woman's body. Generally^ the direction in which 
the blades point determines the line of traction. 



102 



KEY NOTES OF MEDICAL PRACTICE. 

CRANIOTOMY. 



Place patient in position as for application of forceps. 
Evacuate bladder and rectum. Pass fingers of left hand 
up to foetal head, and carefully pass perforator along 
palmar surface until it reaches head, taking care that none 
of the maternal soft parts be injured. Perforate cranium, 
break up and evacuate its contents. Expulsion of child 
may sometimes be effected by the forces of nature. If not, 
apply craniotomy forceps and deliver much the same as in 
ordinary forceps case. 

TWINS. 

As soon as first child is born and separated from mother, 
apply binder about abdomen, and wait for expulsion of 
other. Do not attempt removal of placenta of first until 
after birth of second. If the two placenta? remain in 
vagina, twist cords together and deliver in ordinary 
manner. 



ASPHYXIA OF THE NEW-BORN. 

Clear air-passages of mucus, etc., with finger wrapped 
with handkerchief, the child being inverted. Provide for 
supply of fresh air. Make upward friction on lower limbs. 
Sprinkle face and chest alternately with hot and cold 
water, or, slap buttocks. If not very soon successful, 
resort to artificial respiration. Infant on back — draw 
tongue forward — carry arms well above the head, then 
bring them down to the sides, with elbows flexed, and press 
against sides of chest. Repeat about twenty-five times per 
minute. As soon as respiration restored, apply heat to 
body and extremities, and give five drops of brandy in half 
a teaspoonful of milk and water. 



RETAINED PLACENTA. 

If due to uterine inertia, grasp fundus through abdominal 
walls, and manipulate to excite contractions. If placenta 
adherent, pass hand into uterus and gently and carefully 
detach. Leave no fragments. See to it that uterus is 
firmly contracted afterwards. Follow by antiseptic injec- 
tions. If from hour-ylass contraction, insinuate hand, in 
conical shape, into ring, and gradually and steadily over- 
come resistance of circular uterine fibres. Inhalations of 
Amyl nitrite will aid. 



PUERPERAL MANIA. 



103 



PUERPERAL ECLAMPSIA. 

{Frequency, 1 in 500.) 

LEADING IiKMKI»IKS. 

Belladonna. Convulsive movement of limbs and mus- 
cles of the face; dilated pupils, red or livid countenance, 
fixed or convulsive eyes, foam at the mouth, involuntary 
escape of urine and feeces; renewal of the fits at every 
pain; more or less tossing between the spasms, or deep 
6leep, with grimaces, or starts and cries, with fearful 
visions. 

" If the patient is actually in a convulsion, or the fits are recurring 
rapidly, Bell, is the classical remedy." Hughes. 

Gclsemium. In those cases in which the spasms occur 
with a rigid os uteri. Dose: — Five drops of tincture. 
Veratrum vir. Great arterial tension, with full, hard 
■ bounding pulse. Dose: — Three drops of tincture. 

Hyoscyamus. Bluish color of face; twitching and jacti- 
1 tation of almost every muscle in the body — of face, eyelids, 
and all. Almost constant delirium. 
"A valuable remedy when due to reflex excitability." Hughes. 

Aconite. Hot, dry skin, thirst, restlessness, cerebral 
congestion; general plethora. 
"Acts like a charm." Guernsey . 

' , Opium. Sopor, with stertorous breathing; incoherent 
wanderings, with redness, swelling and heat of the face. 

Chamomilla. From mental emotion, excited by a fit of 
anger. Great excitability. 

GENERAL MEASURES. Remove all sources of irri- 
tation; empty bladder and rectum. Place piece of rubber, 
. or similar substance, between the teeth. If all other means 
fail, give Chloroform to control paroxysms, and terminate 
labor as soon as possible. If urine albuminous, and con- 
vulsions are urcemic, then too the pressure on the ureters 
must be relieved by emptying the uterus. If convulsions 
persist, and cervix unyielding, incise it. 

PUERPERAL MANIA— ACUTE. 

Stramonium. Furious rage. Loquacious delirium, 
throwing off the bedclothes, nymphomania, lascivious talk. 
"In puerperal mania, it stands highest among remedies." Hughes. 
Belladonna. Paroxysms of rage; insomnia; marked 
congestion of the brain, with eyes bright and shining. 

Hyoscyamiis. Delirium of mild type. Incessant, inco- 
herent talking. 

™ Simple mania, characterized more by agitation than excitement, 
In© to the existence of obscure illusions and hallucinations." Lawson. 

Cannabis ind. Mental delusions of an exalted character. 



104 



KEY NOTES OF MEDICAL PRACTICE. 



GENERAL MEASURES. If woman Buffer from ,„■ 
somnin, and mania threatens, or has already set in, it is 
important that she should have sleep. If other methods 
fail, give Chloral, grs. xx, at bed-time. If blood impover- 
ished, give abundance of easily-digested, highly nutritious 
food, fluid in form. 

A FTER- PAINS. 

LEADIXG II KJI KI> 1 BS. 

Arnica. Violent pains, with bruised, sore feeling, pres- 
sure on the bladder, and retention of urine;. after difficult 
labor. 

Gelseniiuni. Numbness of extremities, uterine cramps 
extending upward and backward. Use drop doses of tinct. 
" The medicine on which I am accustomed to rely." Hughes. 

Actea. Rheumatic subjects; excessive irritability, and 
over-sensitiveness. Maerotin acts very promptly. 

Caulopli. After protracted and exhausting labor. Spasl 
modic pains across lower part of abdomen, extending into 
groin. 

liclhulonna. Severe beariug-down, as if everything 
would protrude; pains appear and disappear suddenly; the 
least jar hurts her. 

Chamomilla. Great nervous excitability, pains very dis- 
tressing, rendering patient irritable and ill-natured. 

CotFea. Great sensitiveness, with nervous excitability, 
pains driving to des])air; wakefulness. 

Secale. Pains long and severe. 

Ignatia. Cramplike, with sadness and sighing. 

GENERAL MEASURES. Hot fomentations over ab- 
domen, or warm vaginal injections, sometimes relieve. If 
due to clots retained in uterus, make pressure on fundus, 
and evacuate contents. 

As a rule, do not attempt to check after-pains for at least 
six hours after delivery, as they are often merely caused by 
efforts of the uterus to expel clots or portions of mem- 
brane. 

LACERATION OF PERINEUM. 

Prevention. Freely lubricate perineum, with cosmo- 
line, oil or lard, internally and externally. With two fingers 
in dilated anal orifice, and the thumb on crown of child's 
head, make pressure upwards and forwards, towards pubes. 
•^Frequency: — Average of six observers, 27 per cent, of 
all cases; more frequent in primipane than in multipart. 
Examine for it after every labor. 



LACERATION OF CERVIX. 



105 



OPERATION. Immediate. As booh as placenta deliv- 
ered, cleanse vagina, and, if laceration slight, tie knees 
together. If considerable, cleanse thoroughly, bring wound 
together by interrupted silver-wire sutures, 3 or 4 to the 
inch. Enter suture about an inch from cutaneous margin 
of wound, bringing it out on mucous membrane of vagina, 
very near raw surface, carry to other side, bring together 
and twist ends. 

Secondary. Patient should be in good health, child 
weaned; time, few days after monthly period. Instruments: 
Scalpel; scissors, curved on flat; long, rat-toothed forceps; 
blunt-edged perineum needle; surgeon's needles, curved; 
silver-wire; needle-holder; flexible catheter. 

Patient etherized: lithotomy position; labia? held apart 
by hands of two assistants; shave hair from part; two 
fingers in rectum, draw surface tense, begin in angle of As- 
sure, next to rectum, and freshen surface in triangular shape, 
by snipping with scissors and deunding with knife; torsion 
bleeding arteries; be sure that entire area of surfaces to be 
brought into apposition, is freshened. Success depends on 
care with which sutures are applied. Pass perineum needle 
from cutaneous surface, deeply through tissues, and bring 
point out on vaginal surface, close to edge of wound — 
charge the eye of needle with end of suture, and withdraw 
needle, unthread it, pass it through fold on opposite side, 
thread it with vaginal end of wire, withdraw needle, carry- 
ing the suture in its track. Beginning at angle, pass su- 
tures at regular intervals, 2 or 3 to the inch; coapt parts, 
and secure ends by twisting, leaving long ends, which are 
to be brought together and secured in a short piece of rub- 
ber-tube. 

AFTER-TREATMENT. Draw the urine, put pad between 
knees, and bind them together. Pass catheter three or four 
times daily, and keep vagina clean by mild Carbolic injec- 
tions. Draw urine with care, and hold piece of lint to 
catch any drip. Protect parts by free use of Calendula 
ointment, prepared with Vaseline. Regulate diet so as to 
restrain action of bowels for 5 or 6 days. Remove sutures, 
with great care, on seventh day, and let knees remain bound 
together for week following; after that, only at night. 
Patient should not assume upright position for two weeks. 



LACERATION OF CERVIX. 

Prevention. "With adequate dilatation there can 
be no laceration. The indications are, to procure early, 
prompt and thorough dilatation, by means of fingers and 
forceps. If expulsive efforts set in before cervix is suffi- 



106 



KEY NOTES OF MEDICAL PRACTICE. 



ciently dilated, urge patient to restrain voluntary efforts; 
oppose rapid expulsion by pressure against presenting 
part, and divert its movements in proper channel." R, N. 
Foster. 

TREATMENT. Indicated.— When it is the cause of 
sub-involution, neuralgia or other serious ill-health. Do 
not operate if pelvic peritonitis or cellulitis present, as 
indicated by tenderness in neighboring connective tissue, 
on pressure with finger. 

Preliminaries. — Large hot- water vaginal injections, once 
or twice daily, for several weeks; scarification of cervix if 
mucus follicles enlarged and cystic. 

Instruments. — Vaginal douche; Sims' speculum; volsella; 
double tenaculum; bistoury and scissors; dissecting forceps; 
short needles, straight and curved; needle-holder; medium 
silver-wire sutures. 

Time. — The week following the menstrual flow. 

OPERATION. Patient anaesthetized; lithotomy 
position; large, carbolized, hot-water vaginal injection 
just before operation; dilate vagina, with speculum; 
draw down cervix with volsella or tenaculum; approxi- 
mate edges of cleft to see how much tissue must be 
removed; now open cleft with double tenaculum, in 
hands of assistant ; with long-handled, curved scissors, 
freshen edges of cleft, in V-shape, broad end in angle of 
cleft, narrow towards external os; hook up portion to 
be removed with small tenaculum, and keep it on stretch 
while it is being separated, and, if possible, remove it in 
single piece from side to side; get rid of all cicatricial 
tissue, particularly in angle of cleft, using bistoury, but 
looking out for circular artery, near vaginal junction, where 
tissues must be removed very superficially. If much bleed- 
ing during operation, hot-water injections, from time to 
time, will check. Let vmdenuded portion, which will form 
walls of future cervical canal, be broad, and of uniform 
size and shape. Sutures. — If tissues soft, ?-ound 

needle; if dense, lance-pointed; sutures eight inches long; 
introduce upper one first, — three or four for each side; 
pass beneath onej denuded portion, across fissure, then 
beneath other. In double laceration, pass sutures of both 
sides before tying any. Tie sutures from above down- 
wards. Make accurate approximation of vaginal edges. 
Remove sutures, carefully, on seventh day — uppermost one 
first. 

AFTER-TREATMENT. Confine patient to bed for two 
weeks; empty bladder by catheter for 48 hours; after that, 
water injection after every act of micturition. If much 
discharge, warm, carbolized injection once or twice daily. 



107 



PHLEGMASIA DOLENS. 

LEAIUXii REMEDIGS. 

Aconite. Fever, high temperature, rapid pulse, restless- 
ness, thirst. 

Belladonna. Skin moist, sharp pains in leg, cerebral 
congestion. 

Bryonia. Sharp, shooting pains, aggravated by least 
motion. 

Pulsatilla. Thirstlessness, and in the characteristic sub- 
ject. If patient not doing well under other remedies. 

Hamamelis. When symptoms depend on phlebitis ex- 
tending from uterine into crural veins. 

GENERAL MEASURES. Leg more elevated than 
thigh; straight or bent, as is more comfortable to patient, 
supported on cushions. Apply Hamamelis fomentations, 
wrap with cotton-wool, and cover with oil-silk. After acute 
stage past, bandage from toes to hip with roller, as long as 
oedema lasts. Watch for collections of pus, and, if found, 
evacuate at once. As recovery approaches, use friction and 
faradization. Do not use leg until all disease has disap- 
peared. 

PUERPERAL FEVER. 

LEADI\ti REMEDIES. 

Aconite. If there be chill, followed by high inflamma- 
tory fever, with hot, dry skin, quick, hard pulse, mouth and 
tongue dry, great thirst, vomiting, urine scanty, red and 
hot, cutting, burning, lancinating pains in uterus and abdo- 
men, which is hot to touch, and excessively sensitive to 
slightest pressure. 

"I believe it to be a most valuable remedy." Dr. W. S. Playfair. 

Verat vir. Early stage only. Nausea and violent 
vomiting, empty retching, much congestion of the head, 
full, hard pulse. By some preferred to Aeon ite for the first 
signs of congestion, inflammation, and fever. 

Belladonna. Intense congestion, painful retching and 
vomiting. Abdomen excessively sore and painful, cannot 
bear the slightest jar, violent clutching pains in abdomen, 
with great heat, meteorism, painful bearing down in pelvis, 
suppressed lochia; congestion of head, with flushed face 
and red eyes, throbbing headache and delirium. 

" When the inflammation attacks the peritoneum, Bell, most f re- 
cently required." Hughes. "An excellent remedy for the vomit- 
ing." Baehr. 

Bryonia. If peritoneum involved, and exudation has 
begun. Stitching, lancinating pains in abdomen, worse 



108 



KEY 



from slightest motion, lochia suppressed. Digestive or- 
gans much involved, though without vomiting or diarrhoea. 
Fever not very violent. 

Colocynth. Severe, cutting, colicky pains in bowels, 
excessive tympanites, thin watery diarrhoea. During par- 
oxysms of violent pain, complexion pallid, skin alternately 
cold and hot. pulse quick, distressing vomiting. 

"Quite well indicated when tympanites is excessive." Huglws. 
"An important remedy." Baehr. 

Arsenicum. Sudden sinking of strength, cold, clammy 
perspiration, insatiable thirst, constant vomiting, burning 
pain in abdomen, great anguish, extreme restlessness, rapid 
prostration. Symptoms of decomposition of blood. 

Ver&trum alb. Violent vomiting and diarrhoea, sup- 
pressed lochia, icy-cold extremities, Hippocratic counten- 
ance, cold perspiration, cold breath, threatened collapse. 

" Deserves preference if disease sets in suddenly, with great vio- 
lence." Baehr. 

Nux VOm. When the uterus itself is inflamed — puer- 
peral metritis. 

" I have been .astonished at the rapidity of its action." Hughes. 

GENERAL MEASURES. Washout vagina and uterd 
twice daily with weak solution Kali perman., or Carbolic 
acid. Introduce nozzle of syringe well through the cervix, 
wash cavity of uterus thoroughly until the water issuing 
from vagina is no longer colored. Unsafe to trust this 
important treatment to the nurse. Apply over abdomen 
thin poultice containing an ounce of Turpentine. If tym- 
panites very distressing, enema of Turpentine very service- 
able. Use every antiseptic precaution in management of 
case. 

Diet. Bits of ice in mouth to slake thirst and allay 
vomiting. Important to sustain vital strength by abundant 
nourishment. Give hot milk, strong beef-tea, meat-broths, 
and, if prostration great, cafe-au-lait. If food distasteful, 
give albumen-water. Give small quantities of food at fre- 
quent intervals. 

AGALACTIA. 

LEADING BE!I I.IMKK. 

Asaf<eti<la. Excessive sensibility of vital organism; 
veins of breast much distended. 
" In high repute." Hughes. 

BelL Breasts large and heavy, headache, flushed face, 
cerebral congestion. 
" May afford great aid." Hempel. 

Puis. Often called for — promotes the secretion in many 
cases. 



109 



China. Debility from loss of animal fluids, particularly 
of blood. 

Calc. c. Leucophlegmatic constitution; extremities cold 
and damp; inclined to too frequent and too profuse menses. 

"Sometimes a single dose will effect the desired improvement." 
Hughes. 

Urtica lirens. Entire lack of milk after parturition. 

GENERAL MEASURES. Warm applications to the 
breast will, favor secretion. A strong decoction of the 
castor-oil plant (Rieinus Communis ) applied hot by means 
of soft cloths, has been often successfully used. 

Diet. The use of porter, ale. and other liquors, founded 
on false principles. The patient should have an abund- 
ance of nutritious, easily-digestible food, such as milk, 
cocoa, fresh meats, eggs, broths, and whatever harmless 
food the appetite may crave. Milk-diet is the best. 

MASTITIS. 

I,EAI)I\« REMEDIES. 

Bryonia. Breasts heavy, hot, hard and painful, but not 
very red; breasts gorged with milk, severe stitching pains 
in breast; feels sick on first sitting up. Dose: — 6th or 12th 
dilution. Hughes. 

" The great medicine for mastities. Specific for mastitis neonato- 
rum." Hughes. 

Belladonna. Breasts swollen, hard, glossy, with red 
streaks running in radii: throbbing, stitching pain, accom- 
panied by headache and fever. 

Phytolacca. Chill, fever, painful engorgement, and 
swelling; the drawing of milk impossible; the gland full of 
hard, painful nodosities. 
" In ordinary caked breasts it is considered to be specific." Raue. 

Hepar s. Threatening suppuration, or after suppura- 
tion has begun; the discharge is scanty, and there is still 
great hardness of the inflamed parts. 

Phosphorus. Phlegmonous inflammation; breast swol- 
len, red in spots or streaks, hard nodosities. Fistulous 
openings, with watery, discolored, offensive, ichorous dis- 
charge. 

"Has cured fistulous conditions of breast left behind after milk- 
abscess." Hughes. 

Apis. Burning, stinging pains, with oedema. 

Coninm. When from contusion. "Specific."— Hughes. 

Silica. Chronic fistulous openings. Profuse secretion 
of pus. 

Graphites. When then are so many old cicatrices from 
former abscesses, that the milk can scarcely flow. 
" It has never failed me." Guernsey. 

GENERAL MEASURES. As soon as. hardness appears, 



110 



KEY JNUlitS UJ!' M.JilJUJALi fit, AU 11UI,. 



rub with olive oil, from circumference towards center. 
Support breast with sling of broad handkerchief. Apply 
warm fomentations, by a basin lined with flannel saturated 
with hot water and Phytolacca tinct. If pus has begun to 
form, poultice. In opening abscess, make incision to cor 
respond with radius, and at most dependent part. 

SORE NIPPLES. 

Arnica. Nipples feel sore after nursing. 
Silica. Much ulceration and suppuration. 
Phytolacca. Nipples sore and excoriated. 
Graphites. Minute vesicles, exuding glutinous fluid. 

GENERAL MEASURES. Nipples should be carefully 
washed after each nursing, and child's mouth thoroughly 
cleansed before and after being put to breast. When .sore, I 
Hydrastis and Glycerine, equal parts, applied, will often 
cure. If there are suppurating sores, apply lotion of Cal- 1 
endula tinct., a drachm to an ounce, on soft cloths. If there 
are deep fissures or cracks, touch the raw surfaces with scale i 
of Argent, nit. Lotion of Phytolacca, exceedingly useful; J 
apply in cracked or excoriated nipples, or fissures of syph- 
ilitic origin. Until nipple is entirely well, cover it with 
rubber-shield while child nurses. In those who are subject 
to sore nipples, bathe daily with Arnica lotion. 

METRORRHAGIA. 

L,EAI>IXti REMEDIES. 

Ipecacuanha. After labor or miscarriage; continuous 
flow of bright-red blood; the patient is cold and pale, gasps 
for breath; chilliness and nausea. 

"The first remedy I make use of is always Ipecac." Jahr. "Very fre- 
quently used." Guernsey. 

Sabina. After miscarriage or parturition. Plethoric 
subjects. Haemorrhage profuse, painful; blood fluid and 
mixed with clots; drawing pains from back to pubes, pre- 
cedes the flow. 

" Will help in many cases." Baehr. " Used in frequency next to 
Ipecac.''' Guernsey. 

China. Heaviness of head, ringing in ears, obscuration 
of sight, fainting; face and extremities cold and pale; drow- 
siness; weak pulse; twitching and jerking of muscles. 
After loss of much blood. 

" Will be found of very great service." Guernsey. 

Secale. Haemorrhage from atony of uterus, after pro- 
tracted labor, or in feeble, cachectic subjects. Uninter- 
rupted, painless flow of dark, fluid-blood. Great prostra- 
tion, faintness, palpitation of heart, convulsive movements) 
cold skin. 

" Flooding in feeble, cachectic women." Lilientlial. 



MENORRHAGIA. 



Ill 



Belladonna, Profuse discharge of bright-red, hot blood, 
with downward pressure. Severe pain in the back. Great 
vascular excitement; throbbing of carotids, flushed face, red 
eyes, full, bounding pulse. 

Very frequently indicated in uterine haemorrhage, particularly in 
that after labor." Guernsey. 

Crocus. Pressure and feeling of weight in pelvis, with 
feeling of something rolling in abdomen, and discharge of 
dark, stringy, viscid, tenacious blood. 
"Frequently called for in post-partum haemorrhage. " Guernsey. 
TAMPON. Put patient in Sims' position. With left 
forefinger, or Sims' speculum, retract posterior vaginal 
wall. With pledgets of cotton, or free end of roller-band- 
age, pack vagina posteriori)/ to cervix, then anteriorly, then 
centrally, until firmly filled by plug, taking care not to ob- 
struct urethra. After sufficient time has elapsed, removo 
piecemeal, patient in same position. 

MENORRHAGIA. 

LEADING REMEDIES. 

Crocus. Discharge black, viscid, stringy and tenacious. 
Earthy-yellow face, debility and palpitation. 
" Invaluable in functional form." Hughes. 

Sabina. Plethoric subjects, uterine hyperemia, drawing 
pain from back to pubes, blood bright red. 
" Will cure large number of cases." Matheson. 

Ipecac. Very profuse; constant nausea. 
Secale. Blood dark, without pain, increased by slightest 
motion. 

" Often proves curative." Hughes. 

Hamamelis. Profuse; dark, thin blood. 
Ohamomilla. Black, clotted discharge, with severe 
pains in back. Excessive sensibility, local and general. 
" Has undoubted control." Hughes. 

Nux v. Menses too early and too profuse; stops for a 
day or two, and then returns. Irritability. Sedentary 
habits. 

Trillium. Menses every fourteen days, lasting seven or 
eight days; in interval profuse, yellowish leucorrhoea; blood 
at first bright red, but later is pale. 

" For active flow we possess no better remedy." Hale. 

Calc. C. Menses too early and too profuse and long-last- 
ing; anaemic condition; mal-nutrition ; congestion of head. 

" Sulph. and (ale. c. successively administered during interval be- 
tween periods, required in majority of cases to ensure a radical cure." 
Laurie. 



GENERAL MEASURES. Hot-water bag to lower 
dorsal and lumbar regions. 



112 



KEY NOTES OF MEDICAL PRACTICE. 



DYSMENORRHEA. 

LEADING It EM EDI E». 

Aetea. Severe pains in back, down thighs and through 
the hips. Hysteric spasms, cramps and tenderness of hy- 
pogastrium. Between menses, debility, neuralgic pains, 
tendency to prolapsus. Rheumatic, irritable uterus. 

Caillopliylluin. Spasmodic dysmenorrhoea. Bearing- 
down pains, scanty flow. Sympathetic spasms of adjacent 
organs, as bladder, rectum, bowels. Hysterical spasms of 
chest and larynx. 
I have had great success with Macrotin ami Caulojjhillin, 2x trit. 

Viburnum. Spasmodic dysmenorrhoea. Excruciating, 
colicky pains in lower part of abdomen, coming on sud- 
denly preceding menstrual flow, lasting for hours. Should 
be given for a week previous to flow, in tinct. or lx. 

Cocculus. Sharp, cramp-like pains, with scanty menses, 
distention of abdomen. 

Chamomilla. Pressure iu uterus resembling labor-pains. 
Discharge dark and clotted, with tearing pains, frequent 
desire to urinate. Uterine neuralgia. Excessive irritability 
and impatience. 

Pulsatilla. Menses delayed and scanty; pains so vio- 
lent, she tosses about with cries and tears; blood dark and 
clotted, flows at intervals. Great chilliness. Uterine con- 
gestion. 

Belladonna. Menses too early and too profuse; blood 
bright red. Great downward pressure in genitals. Face 
red and bloated, cerebral congestion. Congestive dysmen- 
orrhea. 

SPECIAL REMEDIES. 

Hamamelis. Of ovarian origin. 

Col litis. Much pelvic congestion. 

Borax. Dysmenorrhoea with sterility. 

Coft'ea. Excessive nervous excitability. 

Sepia. Chronic, with leucorrhoea and debility. 

Gelseniiuni. Spasmodic, to palliate during attack. 

GENERAL MEASURES. Hot fomentations across 
hypogastrium, or hot sitz-bath at time of attack if free flow. 
If flow scanty, spinal ice-bag to lumbar and sacral regions. 
Warm drinks. In spasmodic form, Gelsemium at time of 
attack gives great relief. Dose: — Three to ten drops first- 
decimal, frequently repeated. 

AMENORRHEA. 

LEADING REMEDIES. 
Pulsatilla. Delayed, suppressed or scanty menstrua- 



AMENOKRITtKA. 



113 



tion; pains in abdomen or loins, hysterical symptoms, 
nausea and vomiting, palpitation of the heart, loss of appe- 
tite, deranged digestion, pale face, lassitude, chilliness and 
headache. If patient have light complexion, fair hair, and 
a timid, easily -vexed, yet uncomplaining disposition, this 
remedy is more especially indicated. 
" For the great majority of cases." Hughes. 

Actea. Pain in left breast and side, rheumatic tendency, 
headache, nervous excitement, peevishness; when from 
uterine derangement. Hysterical subjects. 

Sepia. Delayed menses. Sallow complexion, fair, sen- 
sitive skin, feeble, delicate subjects, leucorrhcea, hasrnor- 
roids, and evidence of portal and pelvic congestion. 

Coniuin. General torpor of the organs. The breasts 
become enlarged and painful at every period. Compli- 
cated with ovarian or uterine disease, or chlorosis. 



SPECIAL REMEDIES. 

Aeon. Sudden suppression from cold; congestion of 
head or chest; young, plethoric girls. 

Bry. Bleeding from nose in place of menstrual dis- 
charge; dry, shaking cough; oppression of chest; heaviness 
or pressure in head. 

Calc. <'. Scrofulous subjects, and those inclined to incip- 
ient tuberculosis. Cold, damp feet. 

Plios. Delicate constitution, weak, sensitive lungs, 
cough, expectoration of blood, and pain in the chest. 

Ferrum. Delay of first menses. Debility, languor, 
palpitation, indigestion, leucorrhcea, sickly complexion, 
puffiness of face or ankles. 

Xux v. Patient of dark complexion, vehement disposi- 
tion, sedentary habits; acute indigestion; constipation. 

Graphites. Menses delayed, scanty and painful, con- 
stipation, tendency to eczematous cutaneous eruptions. 

Next to Puis, in frequency of usefulness." Hughes. 

Sulph. Scrofulous eruptions; temporary flushes of heat. 

GENERAL MEASURES. Keep the feet warm, and 
the abdomen covered with flannel. Warm foot-baths are 
useful, or, the cold sitz-bath. Sit in a bath, with water at 
58° or 60°, five to ten minutes, at bed-time, keeping legs 
and feet warm, and shoulders well covered. After the bath, 
the patient should be well rubbed, and retire to bed. This 
is to be used only in the functional variety. When due to 
constitutional derangement, apply the special remedy, and 
prescribe nourishing diet, out-door exercise, and every 
means to restore the general health. In atony of uterus, 
electricity* with Conium. 



114 



KEY NOTES OP MEDICAL PRACTICE. 



LEUCORRH(EA. 

Ii EADIlfG K E M E 1 > I ES . 

Alumina. Profuse, yellow, acrid, corroding discharge 
with burning in genital organs, the parts being corroded 
and inflamed. Worse before and after the menses. Con- 
stipation, inactivity of the rectum. 

Amnion, carb. Watery, burning discharge from the 
uterus; profuse, acrid, milky leucorrhoea; menses every 
fortnight, black, coagulated, profuse. Weak, delicate sub- 
jects. 

Calc. carb. Profuse, milk-like, or yellowish discharge, 
with soreness and swelling of the vulva; too early and too 
profuse menses. Scrofulous subjects, very sensitive to 
cold, with constant cold, damp feet. 

Pulsatilla. Discharge thick, like cream, or, milky, some- 
times giving rise to a burning sensation. Indigestion, 
chilliness, nausea and trembling. Especially for those of 
relaxed fibre and lymphatic temperament, in whom the 
menses are irregular, delayed and scanty. 

" Vaginal leucorrhoea, in chlorotic subjects." Hempel. 

" Specific for morbid activity of cervical glands." Hughes. 

Sepia. Pressure and bearing-down in pelvis, stinging 
pain in ovarian region. Discharge variable — thick, creamy, 
yellowish, bland or excoriating, offensive. Leucorrhoea at 
puberty, during pregnancy, or at climacteric. 

" Debility and passive uterine congestion, in those who have borne 
many children." Hughes. 

Helonias. Uterine leucorrhoea, from atony or conges- 
tion. General debility from over-lactation, or other drain 
on the system. 

Hydrastis. Yellow discharge, of an extremely tenacious 
character, often offensive, frequently with long shreds in 
it. Often accompanied by derangement of liver and 
stomach. 

GENERAL MEASURES. Attention to state of gen- 
eral health, of which this is usually but local expression, 
necessary. Irrigation of vagina with cold water beneficial. 
Calendula-water or Hydrastis-water, better than astringent 
solutions, as injections. 

OVARITIS. 

LEA1HXG REMEDIES. 

Apis. Inflammation of right ovary. Numbness in right 
side, extending down the thighs. Sharp, lancinating, sting- 
ing pains in ovary. This is one of our most reliable reme- 
dies in ovarian affections. 



OVAK1TIS— Cl^LMAUXKUlU. 



115 



Pulsatilla. Sub-acute ovaritis, with menstrual suppres- 
sion, nausea, chilliness, pressure on bladder and rectum; 
pains so violent she tosses about in all directions, with cries 
and tears. 

" I believe it to be far superior to most of the remedies ordinarily 
recommended." Huyhes. 

Belladonna. Hard swelling of ovary, with stitching, 
throbbing pains; constant bearing down in pelvis. Per- 
spiration, glistening eyes, cerebral congestion. 

Lachesis. Inflammation of left ovary, with swelling 
tensive, pressing pains and stitches; cannot bear slightest 
pressure on ovarian region. 

Hamamelis. An excellent remedy in more intense form, 
when peritoneal covering not involved. 

SPECIAIi REMEDIES. 

Aconite. Much fever. 

Merc. s. Threatened abscess. 

Hep. s. To check suppuration. 

Thuja. Chronic, of left side; much pain. 

CoiUUm. Chronic ovaritis, with induration. 

GENERAL MEASURES. Hot fomentations, contain- 
ing Hamamelis, over affected part. Rest. 

CLIMACTERIC. 

Actea. Pain in left side. Pain at vertex and irritability 
of disposition. Faintness at epigastrium. 
" It rarely fails to relieve." Huf/lies. 

Lach. Hot •'flushes,'' burning in the vertex, and faint- 
ness. 

" Of great service." Bayes. 

Gels. Flushes of heat, burning pain in top of head. 
Glonoin. Rush of blood to head, great giddiness, throb- 
bing, beating, roaring in ears. 
" A most efficient remedy." Hughes. 

Platina. Vertigo, palpitation, headache, roaring in 
t ars. For those in whom menstruation has been profuse 
and prolonged. 

Ainyl nit. Flushes of heat. Give by inhalation. 

GENER AL MEASURES. Frequent warm baths help- 
ful in tiding patient over critical period. 



116 



KEY NOTES OK MEDICAL PRACTICE. 



PAET III. 



SURGERY. 



TRACHEOTOMY. 

INDICATIONS. 1. Foreign bodies in trachea, bronchi 
or pharynx. 2. Scald of glottis in children. 3. Prelimi- 
nary to extensive operations about jaws and throat (admin 
ister anaesthetic through tracheal tube). 4. Croup and 
laryngeal diphtheria, with laryngeal dyspnoea, indicated 
by presence of considerable exudation in larynx, and 
respiration so difficult that there is sinking in of sternum 
and of supra-clavicular spaces with each inspiration. Con-< 
tra-indicated: — Auscultate posterior chest — if one lung 
seriously obstructed, tracheotomy contra-indicated. 

Instruments. Scalpel; curved bistoury; tenaculum; two 
strabismus hooks; two or three catch-artery forceps; 
sponges; tube with tapes. 

Chloroform may be given if time permit. Local anaes- 
thesia by ether spray. If no anaesthetic used, wrap child 
in shawl to secure limbs. 

OPERATION. Place patient on firm table in front of 
good light; put small, firm pillow (quart-bottle rolled up 
in a towel will answer) under neck to make trachea prom- 
inent. The operator standing on right side of patient seizes 
trachea between thumb and finger of left hand and fixes it 
until exposed by the incision. The incision should be free, 
extending from cricoid cartilage, from one and one-half to 
two or more inches downward, including integument and 
cellular tissue. It is to be deepened by successive cuts, or 
by hooking of tissues aside until the trachea is reached, the 
operator keeping strictly in the median line. 

The trachea reached, four or five rings should be cleared 
by blunt hooks or handle of scalpel. The operator then 
hooks the tenaculum into the trachea at the highest point 
exposed, and making traction upward (now for the first 
time releasing trachea from grasp of left hand) cuts from 
below upward, with the sharp bistoury,, a sufficient extent of 
trachea to admit the canula. The wound may be held open 



TRACHEOTOMY— HERNIA. 



117 



with the blunt hooks until, by suction, the trachea is cleared 
of blood, mucus or other foreign matters. The outer tube 
may then be inserted, and secured by tying tapes about the 
neck. The inner tube, slightly moistened with glycerine, 
may be put in place, the opening covered with several 
thicknesses of gauze, to filter air, and the patient placed in 
bed. The tube should be large enough to permit quiet 
breathing. 

During operation bleeding vessels may be seized with 
catch-forceps, which are allowed to fall toward the sides of 
the neck, making lateral traction. Free haemorrhage should 
be checked by forcipressure, if time be limited, or torsion, 
if not, before trachea is opened. General oozing, from 
congestion, is best checked by opening of trachea relieving 
congestion, and by pressure of canula. Should thyroid 
isthmus appear in track of incision, hook upward or down- 
ward, or incise. 

After operation the inner tube must be removed often, 
and thoroughly cleansed, the small bristle brushes used for 
feeding-bottles, answering well; or, a stiff feather, properly 
trimmed. 

If operation be made for foreign body, the trachea may 
be held open and body extracted by suitable forceps; if this 
not feasible, insert tube and wait. 

HERNIA. 

REDUCTION'. Tuxis. Anaesthetize patient: place in 
supine position, legs drawn up. Resisting forces: tightness 
of constricting ring, and swelling of strangulated viscus. 
Manipulate hernia as nearly as possible in line of axis of 
ring — -compress gently, but steadily, for long time. While 
keeping up pressure with one hand, with finger and thumb 
of other manipttlate neck of tumor back into abdomen. In- 
sinuate finger-end or nail beneath edge of constricting ring, 
and pull outward. When reduction occurs, bowel goes back 
suddenly, with a gurgle. Aspiration by No. 1 needle occa- 
sionally facilitates reduction after failure of gentle taxis. 
Or, give patient 20 minims Laudanum, place him in warm 
bath for 20 minutes, then between warm blankets, and try 
taxis. 

" Taxis should be gentle and thorough, and tried only once before 
resorting to operation." Adams. 

"Unskilful taxis is a more frequent cause of death than the knife." 
Hamilton. 

Indications for Operation. Symptoms of intestinal 
obstruction with an irreducible hernial protrusion. 

HERNIOTOMY. Instruments:— Scalpel, forceps, direc- 
tor, artery-forceps, ligatures, retractors, hernia-director, 
hernia-knife, sponges and accessories. 

Shave parts and empty bladder. Patient anesthetized, 



118 



KEY NOTES OF MEDICAL PRACTICE. 



supine, thigh slightly abducted and rotated outward. Note 
positions of spine of pubes, Poupart's ligament, femoral 
artery. Make incision free enough to give access to stric- 
ture. Divide coverings of sac layer by layer, on director. 
Tie and cut superficial epigastric artery, if exposed. When 
sac is exposed reduce hernia without opening, if possible. 
If hernia still irreducible, raise small fold of sac at most 
dependent point, make small opening, from which a little 
fluid will escape; introduce director, and on this enlarge 
incision. Division of stricture: — If point of stricture 

is at external ring, make incision upward and outward; if 
at internal ring, insinuate left index finger, and pass the 
finger-nail under the stricture; pass hernia-knife flat, along 
palmar surface of finger, through stricture, turn edge of 
knife directly upward, and cut a mere notch — or 34 inch 
— by pressure of the knife, not by sawing motion. The 
hernia may now be returned by gentle manipulation. 

If gut gangrenous or ulcerated, artificial anus must be 
formed. If omentum inflamed, tie with stout ligature and 
cut off inflamed portion. 

After reduction of hernia, dress wound aseptically, apply 
compress and bandage. Provide for drainage. After- 
treatment: — Rest in bed; liquid food till bowels act; enema 
if bowels do not act in ten days. Peritonitis, treat as from 
other causes. 

TREATMENT OF WOUNDS. 

(Antiseptic Method — Listerism.) 

1. Check hemorrhage by torsion, acupressure, forcipres- 
sure, or cat-gut ligature, cut short. 

2. Cleanse wound of all foreign bodies. 

3. Irrigate with antiseptic solution — Carbolic acid (1 :40), 
Prince's Lotion. 

4. Provide drainage by carbolized horse-hair, glass-silk, 
cat-gut or perforated rubber tube. 

5. Bring edges into exact apposition by carbolized silk 
or gut sutures. 

6. Apply antiseptic dressing. 

The principles of wound dressing are — (a) make wound 
aseptic, and (6) preserve it so. 

The first principle may be carried out, in operation 
wounds, by allowing nothing' (fingers, instruments, etc.,) 
to touch parts unless previously disinfected by thorough 
washing in antiseptic solution; the second, by use of some 
form of dressing which shall prevent access of unpurified 
air to wound. Taking an amputation wound for illustra- 
tion, the dressing may be efficiently made as follows: — The 
wound surfaces having been thoroughly disinfected, drain- 



TREATMENT OF WOUNDS— ABSCESS. 



119 



age provided, and sutures adjusted, the line of the wound, 
and half an inch or more of the surface on each side, are 
covered with Iodoform dusted on thickly; over this is 
placed a strip of aseptic oiled silk, perforated; directly on 
oiled silk is placed Lister's antiseptic gauze, eight layers 
wrung out of 1:40 carbolic lotion, a layer of mackintosh, a 
top layer of dry gauze, and a bandage evenly and firmly 
applied. Drainage tubes are to be cut off flush with the 
skin, and secured, if in danger of slipping, by transfixing 
end with safety-pin. at right angles to wound. 

In a large percentage of cases there will be no necessity 
for changing first dressing for four or five days, when 
drainage-tubes may be removed, and dressings repeated. 

In cases where wounds are not inflicted by surgeon, the 
same method of dressing is to be followed, after thoroughly 
disinfecting wound by irrigation with carbolic lotion (1:20 
or 1:40). Always provide free drainage. Where there is 
tension on wound edges, relieve by deep sutures adjusted 
at some distance. Deep sutures, preferably of silver-wire, 
fastened by means of buttons at each end. 

If, after removal of a tumor (e. g., mammary gland) deep 
cavities exist under flaps, apply pressure by pads of gauze, 
so adjusted as to keep deep portions in exact apposition. 
Complete immobilization of wound necessary. Other anti- 
septics may be used — Boracic, or Salicylic, Acid; Boro-r/lyc- 
eride; Naphthaline; Corrosive sublimate (1:1000) or Tere- 
bene. 

" Under this, or any efficient antiseptic method — wounds heal by first 
intention, patients are free from fever, and cases pursue an aseptic 
course." Adams. 

ABSCESS. 

LEADI\G REMEDIES. 

Hep. S. To avert threatened suppuration; or, when sup- 
puration is inevitable, tumor hard, hot, swollen, with throb- 
bing pains. 

Merc. To avert suppuration. Glandular abscess, with 
nocturnal pain; tumor hard, shining red, beating and 
stinging. 

Bell. Bright redness of affected part, burning, throbbing 
pain, erysipelatous appearance. 

Silica. Fistulous openings, hard to heal, discharge thin 
and watery. Abscess of bone. Chronic abscess. 

Calc. C. After suppuration completed, to promote heal- 
ing. Strumous abscess. 

Slllph. Profuse discharge; tendency to recur, emacia- 
tion, hectic. Strumous abscesses. 



120 



KEY NOTES OF MEDICAL PKACTICE. 



SPEOIAX REMEDIES. 

Cliina. During excessive discharge. 
Ledum. From injuries or splinters. 

Arsen. Foetid, sanious discharge; or threatened gan- 
grene. 

Mezereum. Abscess in fibrous or tendinous structure, or 
from abuse of mercury. 

Rhus tox. Abscess of axillary or parotid glands, dis- 
charge thin and sanious. 

GENERAL MEASURES. Remove splinter or other 
foreign body which irritates. Cover with poultice until 
" ripe " for lancing. Open abscess at most dependent point, 
as soon as pus has formed. All abscesses of size require 
drainage after incision. Deep-seated abscess, in proximity 
to, or underlying, important structures, blood-vessels, etc., 1 
may be opened by Hilton's method, i.e., incise skin, push I 
grooved director through tissues toward purulent collection; 1 
as soon as pus issues along groove of instrument, pass dress- J 
ing or polypus forceps, open them and withdraw, thus I 
making free opening for discharge without endangering I 
vessels. 

Chronic abscesses should never be opened except under I 
strict antiseptic precautions. 

In whitlow, or abscess beneath periosteum, lance clear to 
the bone, early. In thecal abscess, lance in the middle Urn, 
to avoid digital arteries, which run along the sides of the 
finger. 

" Occasionally cure of extensive abscess has followed repeated aspi- 
ration." Adams. 

LOCAL TREATMENT OF ULCERS. 

HEALTHY. Cleanliness; dress with Calcndida lotion 
(3j to ?ij warm water). Protect from external irritation. 

UNHEALTHY. Indolent. Remove source of irrita- 
tion. Remove fungous granulations by knife or caustic 
Arc/, nit. Stimulate surface of ulcer with Carbolic oint. (3i 
,to ? j Vaseline), or powdered Iodoform. For oedema of i 
edges, scarify or use poultices. Apply rubber bandage. 
Method — After ulcer has been thoroughly cleansed (prefer- 
ably by an antiseptic solution), if upon leg, apply bandage I 
from toes up with just sufficient tightness for each turn to 
hold the one preceding without reverses; dress twice a day. 
Healthy action being established, treat as healthy ulcer, or, 
if extent be large, hasten cicatrization by skin-grafting. 

Irritable. Keep part at rest. Apply hot-water, by com- 
press or irrigation. Dress with anodyne pqultices — hops or 
laudanum. Apply caustic thoroughly once. Do not strap 
or bind. 



TREATMENT OF GANGRENE. 



121 



Inflamed. Keep part at rest and elevated. Dress with 
antiseptic poultices — Carbolic, Charcoal, Sodium and Zinc 
chlorides. Avoid compression and caustics. 

Sloughing. ( >ccurs in debilitated and starved cases. 
Treat constitutional condition ; build up general health by 
good, nourishing food and tonics. Local — same as for 
inflamed, unless very active, when Bromine (pure Bromine 
one drachm to water eight ounces) may be employed. 

REMEDIES. 

Arsenicum. Ulcer inflamed, raw-looking surface, which 
is red and hot, and bleeds on slightest touch; thin discharge, 
mixed with blood; edges of sore hard and irregular; intense 
burning pain. 

Lachesis. "Irritable" ulcer ; phagedenic and sloughing 
ulcer; threatened varicose ulcer. Large ulcers, tending to 
extend rapidly, surrounded by small ulcerations or pustules; 
surrounding skin presenting mottled, dark-blue or purple 
appearance. 

Sulphur. Excessive itching, burning, gnawing pains; 
bleeds easily; secretion thick yellow, or thin fetid; margins 
elevated and surrounded by pimples; considerable adjacent 
swelling and discoloration of skin. 

"To begin the treatment of all chronic ulcers." Jahr. 

Mercurius. Deep ulcer, tendency to spread, discharge 
thin and offensive. 

Belladonna. The surrounding skin is the seat of chronic 
inflammation, of erysipelatous appearance. 

Kali bich. Deep ulcer of leg, with hard base and over- 
hanging edge. 

3Iezereum. " Mercurio-syphilitic ulcer of lower ex- 
tremity." Dunham. 

Sanguinaria. Old, indolent ulcers, with callous edges 
and ichorous discharge. 

Hamamelis. Varicose ulcers. 

Scrofulous Ulcers — Cn/c c, Sil., Sulph. 

Phytolacca. Ulcerations of mucous membranes. 

TREATMENT OF GANGRENE. 

Traumatic. In lacerated and contused wounds of ex- 
tremities, bones badly crushed, large vessels torn, limb 
generally disorganized, if gangrene feared, amputation 
should at once be practiced. 

In case of gangrene of an extremity, after attempt being 
made to save it, amputate at once, and in all varieties of 
traumatic where limits of disease can be well-defined and 
whole extremity involved. Superficial sloughs are not to be 
taken for entire destruction of limb. The extent of destruc- 



122 



KEY NOTES OF MEDICAL PRACTICE. 



tion of tissue being small, bring about speedy separation 
of slough by poultices, and hot dressings. Remove dead 
pieces, as they loosen, with scissors and forceps. 

During sloughing, use locally antiseptic poultices, and 
carbolized hot-water dressings. 

During local reaction, no pressure is to be used on injured 
part. 

Gangrene from extreme heat, cold or escharotic, treat on 
expectant plan till line of demarcation formed, then ampu- 
tate if entire thickness of limb involved. 

Gangrene from infiltration of urine in perineo, immedi- 
ately make free incisions to relieve tension and give free 
vent to collections. 

Gangrene from arrested circulation after ligation of 
arterial trunk, apply warmth by cotton, etc., and keep up 
patient's strength until collateral circulation is established. 

CARBUNCLE. 

Iodine, locally, has dispersed. Also lime-water and 
camphor. Early strapping beneficial; encircle with tightly 
applied broad adhesive straps, which will draw the edges 
together. Remove straps daily after discharge has begun, 
and cleanse surface. Keep well poxdticed. Not neces- 
sary to incise unless tension is extreme. After suppura- 
tion established, dress with Carbolic acid and Glycerine. 
If gangrene threaten, dress with powdered charcoal, fre- 
quently renewed — every 3 to 6 hours. 

A commencing carbuncle may be successfully aborted by 
injecting into its center several drops of pure Carbolic acid. 

Never use knife in carbuncle complicating Diabetes. 

LKAIHX<; REMEDIES. 

Arsenicum. Malignant carbuncle. Great prostration 
and restlessness, small, irregular pulse, cold sweats, diar- 
rhoea and fever. 

Bryonia. "Hastens the process of suppuration, reducing 
the period many days." Jahr. 

Belladonna, Smooth, bright-red swelling, tense skin. 

Apis. For extension of erysipelatous swelling. 

Lachesis. Parts look purplish; low inflammatory condi- 
tion; blood-poisoning. 

Arnica. In repeated doses, early, sometimes disperses. 

Silica. After suppuration, to check excessive ulceration, 
and promote healthy granulation. 

Dissection Wounds. Suck the wound immediately, and 
apply Carbolic acid, or cauterize with nitrate of silver. It 
the wound becomes inflamed, dress with hot poultices. In- 



HYDROPHOBIA. 



123 



ternally, Arsenicum. If great prostration, give carbonate 
of ammonium. 

Insect-StingS. For Btings of bee, mosquito, wasp, etc., 
apply Aqua ammonia, or tincture of Ledum pal. Moist 
clay poultice, if nothing else at hand. Remove sting when 
visible. 

Snake-Bites. Tie broad ligature tightly about limb, 
above wound, so as to check circulation. Suck the wound, 
and cauterize with nitrate of silver, strong Carbolic acid or 
a nail heated red-hot. 

Apply ligature, and, as soon as possible, inject with 
hypodermic syringe a solution Permanganate of Potash (1 
to 100), as nearly in line of penetration of serpent's tooth 
as possible. 

The Emperor of Brazil has recently bestowed on Dr. Lacerdo $20,000, 
for his discovery of this antidote. 

Stimulate by injecting Ammonia into the veins, or by its 
internal administration. Keep patient quiet, and conserve 
the strength. Artificial respiration if breathing fall to ten 
per minute. 

The ligature must be occasionally slackened, that the 
poison may but slowly enter the system, and the limb not 
suffer from complete stoppage of circulation for too long a 
time. 

Sprain. Give part absolute rest; immerse immediately 
in hot water, until pain and swelling are reduced. After- 
wards dress with cloth wrung out of lotion of Rhus, Aeon., 
Arn., or Hypericum, and covered with oil-silk. 

After pain has been lessened by immersion in hot water, 
envelop part in absorbent cotton and apply bandage firmly, 
exerting through cotton uniform elastic compression of 
parts. 

Arnica. Contused appearance. 
Rhus. When tendons involved. 
Aconite. Heat, redness and swelling. 
Hypericum. Nerves involved, or lacerated. 

HYDROPHOBIA. 

Belladonna. As soon as a person has been bitten, ad- 
minister Bell, in a low dilution, and keep him under its 
influence for at least six weeks. Also administer it if the 
characteristic Convulsions set in at any time, with great 
burning and accumulation of frothy mucus in the throat, 
constricting sensation when attempting to swallow, redness 
and bloatedness of the face, foaming at the mouth and 
tetanic convulsions. 

" It is only in the largest quantities that its remedial power has been 
most frequently observed." Hughes. 



124 



KEY NOTES OF MEDICAL PRACTICE. 



Stramonium. Convulsions attended by frightful dreams, 
agitated sleep, sudden shrieks, insensible and dilated pupils, 
disposition to bite and tear things with the teeth. 

" Reputed a specific for the disease in China." Hughes. 

Scutellaria. Nightly restlessness, frightful dreams, rapid 
and unequal action of the heart, with pain, tremulousness, 
and twitching of the muscles. 

" Has been found very successful in many cases, both as preventive 
and curative." Laurie. 

GENERAL MEASURES. Immediately suck the wound 
(do not let it come in contact with an abraded surface of 
the mouth), wash it out with a stream of warm water, and 
apply freely pure Carbolic acid. Or, actual cautery may 
be applied. Give Belladonna treatment. 

In Attack. Vapor bath, or Turkish bath. temp. 107 F., 
said to have been successfully used. Give patient bits 
of ice. 

BURNS AND SCALDS. 
CLASSIFICATION. 

First Degree: Hyperemia; erythema; irritation or in- 
flammation of the skin, without vesicles. 

Second Degree: Vesication: inflammation of the skin; 
formation of vesicles and bullae. 

Third Degree: Eschars; gangrene, superficial or deep,- 
involving the skin or any other subcutaneous tissues; car- 
bonization of a part, or of the entire body. 

PROGNOSIS. If one-half, or even one-third, of the 
surface is burned or scalded, death is inevitable. In other 
cases, result depends on location, intensity of heat, nature 
of medium, age, temperament and constitution of patient. 

TREATMENT. 

LOCAL. Apply immediately one of the following: 

Carbolized Vaseline (carb. ac. cryst. five per cent.). 

Carbolized Olive Oil (11 parts oil to 1 part liquid carb. ac.). 

Flour and lard, equal parts, worked together. 

White lead paint. Equal parts linseed oil and lime-ivater. 

Bi-carbonate of soda. Fine wood charcoal. 

Dress to exclude air and keep up warmth of part. 

Probably no dressing equals the carbolized VaselinA 
Use that which can be most quickly obtained. Spread on 
a thick layer, cover with gauze and cotton- wadding, and 
bind lightly. Leave first dressing on as long as possible— 
until offensive nature of discharge or discomfort demand its 
removal. Dress in such a way as to facilitate future dress- 
ings bit by bit. Do not expose too large a surface at once. 



HEMORRHAGE. 



125 



Blisters should be pricked, and contents evacuated, leaving 
the skin as protective covering. In dressing, irrigate with 
edrbolized mater, drachm to pint. 

Iodoform, sprinkled on, relieves pain; put other dressing 
over it. 

In extensive burns or scalds, use continuous tepid bath, 
90° to 10(T F. 

During cicatrization, prevent deformity by position, at- 
tained by splints and mechanical appliances. Employ 
skin-grafting to promote healing of ulcers. 

GENERAL. Treat shock by artificial warmth, rest,' and 
repeated doses of Camphor. For depression, Ammonia as 
stimulant. In exhaustion from profuse suppuration, give 
nourishing food. 

Rhus. Burns of first and second degree. 

Kali bich. Indications of ulceration ot duodenum. 

Cantharis. Vesication; scanty and high-colored urine. 

ILEMOPiKHA(;E. 

Ligature. Cut down upon bleeding point, and tie 
above and below the wound. In case this would involve 
large and deep incision, tie "in continuity." Materials: 
silk, hemp, catgut. Instruments : forceps, retractors, 
directors, artery -forceps, tenaculum (sometimes, aneurism- 
needle). Secure vessel, tie with reef-knot, and, unless cat- 
gut used, one end of ligature must be left hanging out of 
wound. The ligature must be smooth, round, strong, and 
well waxed. 

Torsion. Draw out vessel and make three or four sharp 
rotations of forceps. In large arteries continue rotation 
till sense of resistance has ceased, but do not twist off ends. 
In small arteries the number of rotations of no import- 
ance, and ends may be twisted off or not. 

Acupressure. Compress vessel between needle and loop 
of wire, like common hare-lip suture. In arteries of 
medium size, needle may be removed in four hours. 
Adapted to scalp wounds, and when varicose vei)is burst. 

Cautery. For haemorrhage from neck of womb after 
operation. 

Compression. By tourniquet, Spanish-windlass, or digital. 

Carotid. — Press along inner edge and lower half of 
steruo-mastoid muscle. 

Subclavian. — Push firmly with thumb in subclavian tri- 
angle behind sterno-mastoid. 

Brachial. — Inner border of coraco-brachialis and biceps. 

Femoral. — Under Poupart's ligament, midway between 
anterior superior spinous process of ileum, and the pubes. 

Abdominal Aorta. — Short distance above and to left of 
umbilicus. 



126 KEY NOTES OF MEDICAL PRACTICE. 

In wounds of palm, or where many inosculating vessels 
injured, pack wound tightly with picked lint or other avail- 
able substance, and apply firm bandage. Put limb upon' 
splint to insure perfect rest. 

Flexion. In wounds below shoulder, put arm-pad or roll 
high up in axilla, and bind arm to side. In wound of 
palmar arch, put compress in bend of elbow, flex forearm 
on arm, and pronate hand. In haemorrhage from plantar 
vessels, put pad in popliteal space, flex leg on thigh and 
thigh on abdomen. Or, hang leg, in bend of knee, over 
sharp chair-back. 

Styptics. Ice, applied directly to bleeding surface. Per- 
sulphate of iron (Monsel's solution). Tannic acid, Gallic 
acid, Matico, Alum. Water 120 F. 

GENERAL MEASURES. For faintness and weakness 
caused by loss of blood — horizontal posture; absolute rest;! 
ammonia; ether; wine. Esmarch's bandage, to drive blood ' 
from limbs to vital centers. Transfusion. 

. 

EPLSTAXIS. 

When slight, apply pressure to cheeks, at junction with j 
alae nasi; use nasal douche of hot water, 110° F.; ice to the ' 
nape of neck; use Tannin as snuff; use styptics in solution J 
— alum, iron-persulphate. Enjoin quiet on patient; keep J 
neck straight. 

Plug nostril if severe; pass loop of double thread, by | 
means of catheter or Bellocq's canula, along floor of nose 
to pharynx, seize loop and fasten it to a plug of lint or 
cotton already attached to a string, which "is brought out of 
mouth and retained for withdrawal. By means of the ' 
double thread in nose draw plug into posterior nares and 
tie ends of thread over plug inserted into nostril in front. 
Remove by string through mouth when no longer needed. , 

URETHRAL HEMORRHAGE. j 

Locally, use cold applications, hot injections, Hamamelis,] 
or, introduce catheter and apply compression by means of J 
bandage. If from external, longitudinal wound, make close j 
coaptation by fine sutures and draw water with small! 
catheter four or five times a day. In transverse wound, after I 
haemorrhage is checked, introduce sound at intervals during j 
healing process, to prevent stricture. In haemorrhage into 
tissues about deep urethra, make free incisions to relieve] 
tension, use antiseptic irrigation and keep urethra patent] 
by use of catheter or sound. 



RECTAL HEMORRHAGE — VENESECTION— SHOCK. 



127 



RECTAL HEMORRHAGE. 

When beyond control by use of ordinary remedies, if 
from vessel within reach, apply ligature; if general, and 
styptics and hot water fail, use tampon. To plug properly, 
take cup-shaped sponge or wad of cotton, pass stout double 
ligature through middle, and pass into bowel beyond source 
of haemorrhage. Pack rectum below with pledgets of cot- 
ton, and then draw threads tight, and fasten them over 
compress of cotton placed externally, thus making even 
pressure in all directions. A stiff catheter or tube may be 
placed before plugging, to allow escape of flatus. 

UTERINE HAEMORRHAGE- 

I Method of plugging vagina. — Put patient in Sims' posi- 
tion; with left forefinger, or Sims' speculum, retract poste- 
rior vaginal wall; with pledgets of cotton, or free end of 
roller bandage, pack vagina posteriorly to cervix, then ante- 
riorly, then centrally, until firmly filled by plug, taking care 
not to obstruct urethra. After sufficient time has elapsed, 
remove piecemeal, patient in same position. 

VENESECTION. 

Instruments. Bleeding-tape, or bandage; bowl; lancet; 
. pad; sponge and water. 

Patient recumbent. Apply tape to middle of upper arm, 

tight enough to congest veins, but not to affect pulse. Hang 
: arm down a little while; then choose spot, usually median 
I basilic vein (look out for brachial artery); pass lancet 

gently and obliquely into vein, and enlarge opening without 
. deepening incision. If necessary, make patient work hand, 

opening and shutting it; or, grasp some small object. 
. When sufficient blood withdrawn, remove bandage from 

arm, apply pad to wound, bandage it, by figure-of-8. Wear 

arm in sling for several days. 

SHOCK. 

Loosen everything about neck and chest that can impede 
respiration; body recumbent, head low. Maintain tempera- 
ture of body — warm room, warm blankets, hot bottles to 
extremities, between thighs, in axillae. Hot compress over 
cardiac region. Warm affusion to head. Frictions. If much 
blood lost, and vaso-motor mechanism not paralyzed, trans- 
fusion. Stimulants, not too freely. Brandy, Ammonia, 
Ether. Do not pour fluids down a patient who cannot swal- 
low. Ether has been used with great success. Inject, hypo- 
dermically, thirty minims every five or ten minutes until 



128 



KEY NOTES OF MEDICAL PRACTICE 



patient is able to swallow, then substitute brandy and Am- 
monia, by the mouth. In absence of Ether, employ in I ra- 
venous injection of Ammonia, ten minims of liquid Amm. 
fort. — degree of dilution not material. 

' Digitalis, ten minims, hypodermically, as cardiac 
stimulant — very beneficial. When reaction sets in, give 
warm, nourishing, liquid food, small quantities, frequently 
repeated — coffee and scalded milk, equal parts; milk; beef- 
tea; soup. 

If there is a mangled limb to come off, and shock is slight, 
give Ether, and operate. If shock so grave that reaction 
doubtful, wait several hours till pulse begins to regain 
strength. If temperature below 9(5 F., do not operate. 

ADMINISTRATION OF ANAESTHETICS. 

Chloroform. Commence gently; limit dose to smalleaj 
quantity capable of producing insensibility — gtt. xv. oaj 
towel to begin with; permit free access of air. Ether: — Two! 
drachms to begin; no air; push vigorously, especially in 
stage of excitement. Mixture: — Alcohol, one part; Chlorw 
form, two parts; Ether, three parts; (favorite at Guy's),! 
give as Chloroform. 

Precautions. Do not push too much at first. \Yatch 
quantity used. Allow plenty of air with Chloroform. Have 
provision for admitting free supply of fresh air. Carefully 
watch pulse and respiration, — especially latter. Have 
dressing-forceps ready to grasp tongue. Do not let a flame 
come near Ether vapor. 

TREATMENT OF DANGEROUS SYMPTOMS. 

Give fresh air. Pull tongue well forward. If any diffi- 
culty, tongue may be drawn from off glottis by placing 
thumbs alongside of nose, and the index fingers behind 
ascending ramus of lower jaw, and drawing it forward. 
Clear throat of blood or vomited matter. Hot affusion to 
head. Invert patient. Artificial respiration. Inhalations 
Nitrite Amyl. Galvanism — one pole on throat near phrenic 
nerve, other at pit of stomach; or, through skin at sides of 
nose. 

Local Anaesthesia. Two parts crushed ice to one part 
salt, in gauze bag. Ether spray. Do not freeze part. 

TREPANNING. 

If there be already a scalp wound, enlarge it; if not, shave 
scalp and make U-shaped incision down to bone, and peel 
back periosteum with the flap of the scalp. Avoid regions 



HARE-LIP — NJ2VUS. 



129 



of longitudinal and transverse sinuses, and middle menin- 
geal artery. Adjust trephine so that pin shall project 
beyond teeth. If there be fracture, place teeth on firm 
edge of bone. In working, press evenly on all skies. After 
penetrating short distance, withdraw pin into crown of tre- 
phine. As dura mater approached, proceed gently, and 
frequently probe with piece of quill, obliquely sharpened to 
a point. As soon as dura mater detected, tilt trephine to 
other side. When loose enough, remove disc of bone with 
elevator. 

Dangers. Wounding dura mater; haemorrhage. 

Haemorrhage, from abnormally large veins in diploe, can 
be arrested by pressure of ball of carbolized wax, softened 
in hot water; from wounded artery, pressure with ball of 
wax; from sinuses, light compress. 

HAEE-LIP. 

Best time to operate, third to fifth month of infancy. 
Contra-indicated — during dentition or ill-health. Chloro- 
form unnecessary. Apply small bag of pounded ice and 
salt, till local anaesthesia induced. Child held in assistant's 
lap. Secure limbs by rolling him lightly but firmly in a 
shawl. Assistant to check haemorrhage by holding each side 
of the upper lip between finger and thumb. Begin by sepa- 
rating, with knife, the two sides of the lip from the jaw 
subjacent, unless former structures be already very free. 
Then pare edges of cleft. Kemove enough, especially from 
apex of cleft, and junction of cleft with edge of lips. Coapt 
edges, insert two "hare-lip" pins; enter and exit V4 inch 
from fissure; pass deeply, nearly reaching mucous mem- 
brane. Lower one secures coronary artery. Secure with 
hare-lip suture. Interrupted wire suture at red border of 
lip. Sharp ends of pins nipped off. Pieces of lint placed 
beneath ends of pins. Strapping, broad at ends and nar- 
row in middle, brought across lips. All pins must be re- 
moved on third day, very gently, lips being well supported 
at time, and strapped immediately afterward. Instead of 
pins, the interrupted suture of wire, aseptic silk or gut may 
be used. 

NjEVUS. 

Capillary na?vi may be successfully treated by successive 
paintings with liquid carbolic acid, nitric acid, lunar caustic, 
or by puncture at various points with hot needle. More 
extensive forms may be treated by (1) compression ; (2) 
ligature, which shouid be subcutaneous, to avoid scar; (3) 
excision ; (4) by ligature of vessel of supply. 

Injections info ncevi should never be employed. 

5 



130 



KEY NOTES OF MEDICAL PRACTICE. 



INTUSSUSCEPTION. 

Plumbum. Oolic and fecal vomiting. 

Aeon., Bell. To obviate inflammation. 

Opium. Meteorism, and stercoraceous vomiting. 

Nux vom. To correct irregular and excessive peristalsis. 

GENERAL TREATMENT. Early in attack— place 
patient on back, hips elevated, shoulders low; introduce , 
long tube into rectum, passing it as high up as possible, and ' 
slowly inject large quantities of warm water or olive oil. As 
the fluid is coming away, manipulate abdomen with hands, I 
so as to move coils of intestines. Repeat entire process i 
several times, if necessary. Sometimes well to anaesthetize . 
patient preparatory to operation. Also try inverting 
patient. In children, inflate bowel with air until abdomen 
is much distended. Keep stimulants at hand, as syncope 
sometimes occurs. 

In cases where above measures fail, and diagnosis of j 
obstruction clearly made, perform laparotomy with antisep- j 
tic precautions. Operation, preferably in median line, ' 
consists in exposing peritoneum by incision of three to five I 
inches, checking all haemorrhage, opening peritoneum, 
searching for obstruction and relieving it according to its 
nature. 

THORACENTESIS. 

Indications. Amount of effusion great, with dyspnoea; 
old effusion, which remains stationary. 

OPERATION. Use aspirator; needle moistened with 
oil; slight preliminary incision. Introduce near axillary 
line, fifth intercostal space on left side, fourth on right, or 
seventh, near angle of scapula, posteriorly. Insinuate 
needle with twisting motion, near upper border of lower- 
most rib. Then plunge needle smartly through pleura, 
turn cock of aspirator and collect fluid. 

Dangers. Wounding intercostal vessels, lung or dia- ' 
phragm; rupture of pleura or capillaries by excessive suo- \ 
tion with aspirator; admission of air. ' 

PARACENTECIS ABDOMINIS. 

Indications. Called for if amount of effusion so great J 
as to seriously embarrass res2>iration or heart's action. 

Operation. Make ink-mark exactly in median line, mid- i 
way between umbilicus and pubes. Turn patient on side, 
near edge of bed. Bladder must be empty. Ascertain by j 
percussion presence of fluid at spot to be pierced. Apply j 



PNEUMATIC ASPIRATION— HEMORRHOIDS. 131 



broad flannel belt, or a sheet, around abdomen, the ends 
crossed behind, and held by assistant, who gradually draws 
it tight as fluid is withdrawn. Tap through hole cut in cloth 
at proper point. Incise skin at point selected, and intro- 
duce trocar. Draw off fluid slowly. When all out, seal 
wound with plaster, and pin the band tightly around ab- 
domen. 

Dangers. (1) Haemorrhage, from not keeping to middle 
• line. (2) Wound of bladder, from not emptying it. (3) 
Wound of bowel, from not tapping in thoroughly dull spot, 
or from plunging trocar too deeply. (4) Fainting. 

PNEUMATIC ASPIRATION 

May be practiced in any part of the body — and is a safe 
procedure as long as only the fine needle (No. 1.) be used. 
Aspiration with the larger needles is to be practiced with 
the same caution as tapping with trocar, the risk of aspira- 
tion equaling that of tapping when the larger needles are 
used. 

HAEMORRHOIDS. 

Internal. Of capillary variety — viz., elevated thickenings 
of mucous membrane — best treated by application through 
speculum, with wooden spatula or glass rod, of pure nitric 
acid. Forcible dilatation of sphincter, occasionally cures by 
relief to circulation during partial paralysis of sphincter 
following dilatation. Internal haemorrhoids, more or less 
pendulous, best treated by (a) Injection of mixture of equal 
parts of Glycerine and Carbolic acid. To do this safely, 
clamp base of pile with forceps, so as to interrupt circulation; 
with hypodermic syringe, charged with mixture, insert needle 
into substance of haemorrhoid and inject M. v ad x. Repeat 
injection at intervals of three or four days until tumors- 
shrivel and slough away. (b) Ligature. — Patient under 
ether; dilate sphincter, forcibly seize haemorrhoid with for- 
ceps; with curved scissors dissect haemorrhoid slightly from 
mucous membrane from below upward, thus avoiding vessels 
which always enter pile from above; — transfix pile with 
threaded needle and tie firmly on each side ; repeat process 
on all internal piles. Confine patient strictly to bed for a 
week. Ligatures come away generally in four to five days. 
Patient should take no exercise of amount for ten to four- 
teen days. 

External haemorrhoids, when seen early, i.e., during first 
forty-eight hours, should be incised and the clot of extrava- 
sated blood, which gives pain by causing tension of tissues, 
turned out. Always incise in line radiating from anal cen- 
tre. If ancient, and source of annoyance, remove by scis- 
sors, clipping away tab of thickened integument in line 
radiating from anal centre. 



132 



KEY NOTES OP MEDICAL PRACTICE. 



ANAL FISSURE. 

When productive of slight degree of suffering, may be 
treated by application of Iodoform, in powder or supposi- 
tory. A single application of Nitrate of silver to fissure will 
sometimes suffice. Severe forms only amenable to treat- 
ment by incision or forcible dilatation. 

To incise, expose part thoroughly and cut through base of 
fissure deeply enough to divide the superficial fibres of the 
sphincter directly under it, then apply Iodoform, cotton 
pad and T bandage. 

To dilute, put patient under ether, insert thumbs into rec- 
tum back to back, and stretch sphincter until the thumbs 
touch tuber ischii, or sphincter is thoroughly relaxed. 
Dress as above. 

RECTAL STRICTURE. 

Gradual dilatation with bougies at intervals of three or 
four days, safest but slowest method. If stricture be thin, 
and bridle-like, nick edge of constriction at three or four 
points in circumference, and pass bougie. 

Posterior rectotomy to be employed if stricture irritable 
and of small calibre. Patient under ether; with straight 
probe-pointed knife, cut through stricture and sphincter 
towards coccyx, keeping incision strictly in median line. 
Keep patient recumbent, pack wound with antiseptic cotton, 
and, as it heals, pass bougie to preserve calibre of rectum. 

RECTAL FISTULA. 

Three varieties — result of abscess in submucous tissue 
of rectum — interna], external, and complete. 

Internal should be made complete by passing a probe, 
bent into hook-shape, into rectal opening and making it 
project integument, cut down on end of probe and operate 
as for complete. 

External should be made complete by passing director 
into external opening to thinnest portion of rectal wall, deter- 
mined by finger in rectum, and forcing director through 
into rectum. 

Complete fistula may be treated by incision on director, 
or, in timid patients, by elastic ligature. To incise, put 
patient under ether, pass grooved director through fistule, 
bring point out at anus and cut all overlying tissue ; slit up 
sinuses leading into fistule, pack wound with oakum for first 
forty-eight hours, and then dress with Iodoform, keeping 
patient recumbent until wound is fairly filled by granula- 
tions. 

To ligature, take solid rubber cord % inch in diameter. 



RETENTION OF URINE — CIRCUMCISION. 



133 



pass silk cord through fistule by means of eyed probe, draw 
rubber cord through double, pull tense, and tie tightly, over- 
tying rubber knot with silk to prevent slipping. Under this 
method patient may move about. 

COCCYGODINIA. 

If obstinate, divide subcutaneously all muscular and liga- 
mentous structures from borders and tip of coccyx. If 
coccyx luxated and displaced, or carious, remove it. 

RETENTION OF URINE. 

From Stricture. Put patient in warm bath to relax 
spasm; pass small catheter, or filiform bougie, which use as 
a guide for tunnelled catheter. If filiform bougie or small 
catheter passes, tie in for continuous dilatation, replacing it 
by larger size in twenty-four hours. If stricture is impassa- 
ble, relieve bladder two or three times in twenty-four hours 
by aspiration, supra-pubic. After two or three days, attempt 
passage of instrument again. If instrument cannot be 
passed, and fistulous opening exist, perineal section should 
be j^erformed. 

From Enlarged Prostate. Pass soft-rubber catheter. 
Mercier's elbowed catheter, or over-curved gum-elastic 
catheter. If retention has existed for some time, do not 
empty bladder at once, but at third or fourth catheterization, 
after which keep bladder clear of residual urine. When 
bladder is completely closed by hypertrophy of prostate 
plus inflammation, supra-pubic aspiration may be practiced 
twice or thrice daily, until catheter may be passed. 

" If catheterism impossible, supra-pubic puncture and introduction 
of permanent tube relieves retention, and, when done early enough is 
followed by subsidence of prostatic overyroicth.''' 1 Adams. 

CIRCUMCISION. 

Draw foreskin well forward and hold by compression be- 
tween blades of forceps applied where section is deemed 
best; cut off portion included in forceps, split up mucous 
membrane to corona, turn back, trim edges, and unite to 
skin by numerous fine sutures of cat-gut. In infants sutures 
are unnecessary. Dress by enveloping part in strip of sheet 
lint which should be kept moist with 1 to 40 carbolic lotion. 
Treat haemorrhage by torsion if not spontaneously checked. 

Ganglion. Rupture it by placing patient's wrist on your 
knee, steady it with your fingers, while you squeeze the 
ganglion, with ends of both your thumbs, against ridge of 



134 KL A Ll\JJ i,,-> wi Mi.i i' X WAVAAVJim 

bone beneath. Other methods failing, employ subcutaneous 
puncture, and follow either method by pressure with pad 
and bandage. 

Bullion. Remove pressure of boot, which is always cause; 
restore toe to natural position by mechanical contrivance. 
Use corn plaster; soap plaster; arnica plaster. If it dis- 
charge, stimulating dressing. When inflamed, poultices, 
fomentations. 

Corns. Soak foot in warm bath half an hour or an hour, 
extract hard head with finger-nail, or blunt instrument, 
dress with Arnica lotion, wear during day Arnica plaster, 
and felt, with hole in centre. Repeat this several days, and 
wear easy shoes, and there will be no more return. 

In-growing toe-nail. With point of pen-knife insinu- 
ate a bit of cotton beneath side of nail, and between edge 
of flesh and over-lapping nail. Poultice and rest if much 
inflammation. 

If scraping nail in middle fails to relieve, pare away over- 
lapping flesh — remove underlying portion of nail; or, these 
measures failing, remove entire nail by avulsion under 
annesthetic. 

THE VENEREAL. 

SYPHILIS. 

Period of Incubation. A chancre (if not modified by 
treatment) will usually be followed by secondary symptoms 
within fifty days, and always within six months. It may be 
as short as ten days. 

TABLE GIVING USUAL PERIOD OF DEVELOPMENT 
OF LESIONS. 

Lesion. 

1. Roseola 

2. Lichen 

3. Mucous patches 

4. Sec'd aft. fauces 

5. Vesic. erup 

6. Pustular 

7. Rupia 

8. Iritis 

9. Sarcocele 

10. Periostitis 

11. Tuberc. erup 

12. Serpig. erup 

13. Gummy tumors . . 

14. Opychia 

15. Exostosis 

16. Ostitis 

17. Destruct. vel. pal 



Usual May Delay 
No. Days. as long as 
.. 25 to 45 12 months. 

. .28 to 65.. 12 " 

. 30 to 70 18 " 

..50 to 70 18 " 

. . 55 to 90 , 6 " 

. .45 to 80 4 " 

. . 7 m. to 2 yrs 4 " 

. . 2 to 6 ms l year. 

. . 6 to 12 " 3 years. 

. . 4 to 6 " 2 " 

. . 3 to 5 yrs 2 " 

.. 3 to 5 " 20 " 

.. 4 to 6 " 15 " 

. . 3 to 6 " 22 " 

. . 2 to 6 " 20 " 

.. 2 to 4 " 41 " 

. . 2 to 4 " 20 " 



SYPHILIS. 



135 



No one who has had syphilis should marry until he has 
been free from all symptoms for a period of at least three 
years. 

Chancre. - Chancroid. 



1. A general blood disease. 

2. From inoculation with syph il- 

itie virus. 

3. Incubation, ten to sixty days 

or more. 

4. Auto-inoculation impossible. 

5. Lesion, usually an excoriation 

or indurated shallow ulcer. 

6. Number, usually single. 

7. Secretion scanty, serous, san- 

guinolent. 

8. Edges slanting, adherent. 

9. Generally painless. 

10. Phagedena very rare. 

11. Bilbo invariable; seldom sup- 

purates. 

12. Second attack very rare. 

13. Local treatment unimportant. 



1. A local tissue disease. 

2. From inoculation with chan- 

croidal virus. 

3. Incubation, none. 

4. Auto-inoculation always pos- 

sible. 

5. Lesion, a rapidly-spreading, 

soft ulcer. 

6. Number, often multiple. 

7. Secretion, creamy, free. 

8. Edges, perpendicular or un- 

dermined. 

9. Often painful. 

10. Phagedsena not uncommon. 

11. Bubo in about one-third the 

cases; often suppurates. 

12. Second attack possible. 

13. Local treatment highly im- 

portant. 



SYPHILIS. 

Definition. A specific, infectious disease, having a 
period of incubation, and characterized by the appearance 
of a chancre, then by eruptions on the skin and mucous 
membranes, subsequently by chronic inflammations of the 
cellulo-vascular tissues and the bones, and finally by small 
tumors, or gummata. 

One attack affords protection against a second. The 
initial lesion is always a chancre, whether the source of 
infection be a chancre, or a secondary lesion. A perfect 
recovery from syphilis is possible (Kcyes). 

Initial lesion. Varies. May be hard, desquamating 
papule, a raw erosion, or a superficial ulcer. Indurated 
chancre — generally solitary, shallow, borders adherent and 
sloping, base indurated, floor grayish, the secretion thin, 
scanty, non-purulent. It is indolent and generally painless. 

TREATMENT. 

PRIMARY STAGE. 

Merc. sol. This is the only remedy worthy of confidence 
in the treatment of recent, uncomplicated chancre. Chan- 
cre with red edges, lardaceous bottom, painful and readily 
bleeding: indurated base and margin. Dose, lx to 6x trit., 
a grain night and morning. 

"Stands in the front rank." Franklin. " Only remedy for the un- 
complicated forms." Baehr. " Enjoys universal confidence." Hughes. 

Merc. corr. For phagedaenic chancre; ulcer secreting 



5 



136 



KEY NOTES OF MEDICAL PRACTICE. 



thin, ichorous pus. Secondary symptoms make early 
appearance. 

Merc. iod. Painless chancres; glandular system largely 
involved; inguinal glands large, swollen, but not inclined to 
suppurate. 

Arsenicum. Gangrenous chancre. Ulcers with florid, 
unhealthy granulations; or, secreting a watery, corrosive, < 
offensive fluid. 

"In gangrenous, never fails." Jahr. "Only efficient remedy." 
Baehr. 

Nitric acid. For chancre of some weeks' standing that 
has been treated with large doses of Mercury. Ulcer bleeds 
easily and profusely; pale, flabby, prominent granulations; ] 
fungous growths; corrosive discharge. 

Arsen. iod. For swelling of inguinal and axillary glands, 
threatening suppuration. 

" Excels all other remedies in the rapid cure of venereal bubo." I 
H. Noah Martin. 

Bilbo. Requires same treatment as chancre from which 
it proceeds. For acute bubo, Merc, sol.; for indolent bubo, ] 

Merc. iod. 

Local. Observe strict cleanliness of the parts. To pri- J 
mary sore, apply simple lint, soaked in cold or tepid Calen- 1 
dula lotion, renewed every three or four hours. Chloral I 
Hydrate, solution, grs. xx. to 3j aqua, hastens healing pro- | 
cess. If discharge fetid, sprinkle with powdered Chlorate j 
of Potash, and cover with wet compress; renew frequently. 

For sloughy ulcers, apply slightly caustic solution Nitric 
Acid, or Carbolic Acid. 

General. Avoid stimulants, excitement, over-exertion, 
and excesses of all kinds. Let the surroundings be the 
most favorable, hygienically, that can be procured. Have 
fresh air, moderate out-door exercise, and a plain diet. 
Encourage in the patient hopes of ultimate recovery. 
Frequent bathing of the skin very beneficial. 

SECONDARY AND TERTIARY. 

Mercurius. Feverishness, rash, sore throat ; rheumatoid 
pains, aggravated by rest and the warmth of the bed. 
Erythematous, papular and squamous eruptions. Superfi- 1 
cial ulcers in the throat. Iritis. Fauces and tonsils swollen, J 
inflamed and ulcerated. Emaciation, with slow, hectic I 
fever. 

Kali hyd. For secondary and tertiary forms, particu- 
larly in those who have been over-dosed with Mercury. I 
Nodes, gummata, erythema, tubercular skin eruptions, i 
ulcers on tonsils, periostitis, coryza. Iritis. Ulceration of 
nose, mouth or throat, with corrosive, burning discharge. 
Pain in nodes quickly relieved, and the nodes soon disap- 



CHANCROID. 



137 



pear. Dose: — Give grs. j. to v. of the crude drug ter die; 
in obstinate cases, grs. xv. to xx., ter die. 

" No remedy surpasses this as an antidote to the syphilitic poison in 
the secondary, and especially in the tertiary form of the disease." 
Franklin. 1 We have nothing to take the place of the Iodide of Potash, 
in tertiary syphilis." Hughes. 

Aurum. Syphilophobia. Ozaena, with caries of nasal 
and facial bones. Ulcers of nose and mouth, with fetid 
discharge. Nodes of cranial bones. Sarcocele. Lupus. 
Syphilitic rheumatism. Suicidal melancholia. 

"Covers nearly the whole field of the tertiary, with its cachexia." 
Hughes. 

Nitric acid. Ulceration of the mouth, and cracks about 
the commissures of the lips. 

Kali Inch. Indolent ulceration of the tonsils. Affec- 
tions of the throat, eyes, skin and periosteum. 

Rupia. Thuja. 

Sarcocele. Aurum. 

Iritis. Merc, Kali hyd. 

Grummata. Merc, Kali hyd. 

Ozflena. Aur., Kali bi., Kali rhlor., Kali hyd. 

Condylomata. Ac. nit, Thuja., Merc, Ant. tart, Ac. 
phos. 

Caries of Bone. Aur., Mez., Phos., Kali hyd., Merc, 
Acfluor. 

Throat, ulceration of. Merc, Kali hi., Ac nit, lod., 
Kali iod., Hydr.. Ac. fluor. 

CHANCROID. 

S VX( >NYM : Soft Chancre. 

Definition. A virulent, local, contagious ulcer, never 
giving rise to constitutional symptoms, its effects being 
limited to the vicinity of the sore, and the neighboring 
lymphatic glands. 

It is never transmitted by inheritance. It is auto-inocu- 
lable. A person may have repeated attacks. The prognosis 
is always favorable. 

Lesion. A round or oval ulcer, surrounded by a faint, 
pink areola, with abrupt edges, sharply cut at right angles 
to surface, often slightly undermined, the bottom being 
irregular, soft, and covered with pultaceous, dirty-yellow pus. 

THE ATM EXT. 

REMEDIES. Merc, Ars.. Acid nit.. Kali hi.. Hep. s.. 
Phos. ac, Silica. 

Local. Touch with strong Nitric acid. Before cauteriz- 
ing, cleanse surrounding parts with Carbolic lotion. Do not 
cauterize unless the whole of diseased surface can be acted 
on. Chancres beneath phimosed prepuce, treat by frequent 



138 



KEY NOTES OF MEDICAL PRACTICE. 



injections Carbolic lotion (1 to 40), using syringe with long 
nozzle. 

When caustic not used, best application is Iodoform; dust 
on powdered crystals, cover with dry lint, and use retaining 
dressings. 

Dressings of all kinds must be changed frequently, and 
opposing surfaces be kept apart. Destroy old dressings. 
Use no greasy applications. 

PARAPHIMOSIS. 

If strangulation occur, effect reduction. In phimosis, if 
swelling so great as to prevent use of syringe, or if slough- 
ing threaten, slit up prepuce, by double incision, or remove 
altogether, and treat as phagedena. Otherwise, hot, local 
baths to reduce oedema. 

PHAGEDENA. 

Immerse entire diseased part in bath at 98 F., and main- 
tain this heat for nine or ten hours per day. Use hip-bath. 
Continue for several days after sore puts on healthy appear- 
ance. Let patient go to bed at night, dressing sore with 
Iodoform. If disease not arrested, make bath continuous. 
Full bath, in which patient can lie down, will accomplish 
this. If milder measures fail, cauterize. Check all haem- 
orrhage at once; apply to bleeding point pledget of lint 
soaked in solution jjersulphate of iron, retained by firm 
bandage. 

Gknebal. Rest; good food; good ventilation. In phage- 
dena, tonics and cod-liver oil. 

BUBO. 

To favor resolution, use pressure and dry heat. If sup- 
puration be found to be inevitable, promote with poultices, 
open by free incision across line of Poupart's ligament, as 
soon as presence of pus is manifest, and treat same as local 
sore. Aspiration of no service. 

GONORRHOEA. 
EEADIX^ remedies. 

ACUTE STAGE. 

Gelseiniiim. Recent cases. Discharge moderate. Much 
irritation, considerable heat, little pain, smarting and red- 
ness at meatus. Dose: — gtt. j to ij every three hours. 

"Has a striking effect on the acute stago of gonorrhoea, usually 
bringing relief in twenty-four to forty-eight hours. Fully ninety per 
cent, of cases report speedy relief." Arlams. 



GONORRHOEA. 



139 



Cannabis, sat. tinct. Smarting, burning, stinging, dur- 
ing micturition; constant urging; copious, thin discharge; 
prepuce swollen and painful. Strangury, pains extending 
into scrotum, with dragging in testicles. 

"A characteristic indication for this remedy is priapism." Adams. 

Cantharis, 2\. "When urinary symptoms indicate that 
inflammation is extending toward bladder. Ardor urince, 
cutting, stinging pain during and after micturition. 

"Particularly called for when blood occurs, either free or mixed with 
discharge." Adams. 

Mercurius, 2\. "When inflammatory process is accom- 
panied by free exudation into submucous tissue and thick- 
ening of the urethral walls, producing great diminution in 
the size of the stream of urine, and chordee." Adams. 

Local. Astringent and irritative injections of doubtful 
utility. Observe strict cleanliness of part. To absorb and 
remove discharge, keep piece of lint over meatus, retained 
by drawing prepuce over it, or a piece of soft linen, with 
hole in center, drawn, like a collar, just back of corona 
glandis, and corners then brought forward, with prepuce 
over it. Avoid use of warm and cumbersome dressings; 
tissue-paper is best. Renew dressings . frequently, and 
destroy old ones. Wear light suspensory for scrotum. 

If, after well-conducted course of treatment, a "drop or 
two" still appear, suspect incipient stricture and use me- 
chanical dilatation. 

Diet. Avoid all greasy, fried, or highly-seasoned articles, 
pepper, vinegar, salt, coffee or tea. Salad-dressings, 
asparagus, acid fruits, tomatoes, strawberries, pastries, and 
particulary all malt, vinous and spirituous liquors should 
be strictly prohibited. Let the diet be light. Plain milk- 
diet best. Drink large quantities of soft water, 
■ General. Rest in recumbent posture will greatly pro- 
mote recovery. In any event, to as great an extent as 
possible, avoid physical exertion, and all sexual excitement. 

Chordee. Empty rectum by enema before retiring. 
Sleep on hard mattress, with light bed-clothes; room cool 
and well ventilated. When erection occurs, evacuate blad- 
der; stand on cold oil-cloth. Medicinal treatment as for 
original disease. External application of Camphor-ice 
along urethra, at night, has prevented chordee. 

Injections. Useful in but small number of cases. Hot 
mucilaginous infusions best — gum-water, linseed-water, with 
a little Hydrastis. Any injection which causes greater 
pain than very slight smarting, will do more harm than 
good. In any case, must be employed very early — later, of 
no use. 

Retention of Urine. Avoid passage of catheter 1/ pos- 
sible! Quiet mental anxiety; inject in perineum Morphia 
gr. and Atropia gr. 1-120; repeat in an hour; place pa- 



HO 



KEY NOTES OF MEDICAL PRACTICE. 



tient in hot bath, submerged to the chin, until flow of urine 
begins; if signs of syncope, remove him from bath, put hot 
mush poultice over hypogastrium, and give enema of hot 
water and soapsuds, All other means failing, aspirate the 
bladder. 

STAGE OF DECLINE. 

Merc. iod. Discharge free and mucoid; patches of indu- 
ration found along urethra. 

Sepia. Chronic mucoid discharges, without pain. Espe- 
cially gonorrhoea of females. 

Hepar s. Mu co-purulent discharge in those who have 
had several attacks. 

Thuja. Thin, whitish, painless discharge. Sub-acute 
and chronic cases, especially when there is inflammation of 
prostate. 

Sulph. Much thickening along urethra. 
Silica. Cases of long standing, with slight, shreddy dis- 
charge. 

Injections. May be used in this stage. Half a grain or 
grain of Arg-nit., Zinc sulph. or Plumb, acet, to ounce of 
water. Powdered Hydrastis ~ss. to ?j water, excellent in 
cases of long standing. 

Short-nosed, hard rubber syringe holding Zij. First 
clear urethra by urination, or warm water. Insert nozzle 
just within meatus; compress sides of urethra with thumb 
and finger above syringe tip; inject slowly. Retain injec- 
tion for minute or two, manipulating urethra. 

If discharge persist, pass slowly full-sized, smooth, steel 
sound, at intervals of three or four days. 

GLEET. 

Treat by slightly astringent injections, and remedies as 
indicated above. But permanent cure demands treat- 
ment of the accompanying 

URETHRAL STRICTUR E. 

Chronic urethral discharge always indicates stricture, and 
latter must be treated. Pass olive-pointed bougie, not be- 
yond prostate, using no force. If meatus contracted, with 
keen-edged bistoury cut downward and backward in median 
line, and insert piece of oiled lint to prevent primary adhe- 
sion. Make gradual dilatation at point of stricture with 
olive-pointed bougies up to No. 8, then steel sounds. Never 
use steel sound smaller than No. 9. 

Leave bougie in situ only few moments, and introduce 



HYDROCELE. 



141 



larger sizes at intervals of two days, more or less, accord- 
ing to patient's urethral sensibility. Use no force. Make 
haste sloichj. Gradual dilatation should be carried up to 
normal size of urethra, as ascertained by bulbous bougie, 
or urethrometer. Traumatic and resilient strictures, and 
those of the penile urethra, should be treated by over-dis- 
tention and urethrotomy combined. 

EPIDIDYMITIS AND ORCHITIS. 

LEADING It KMEDIES. 

Pulsatilla. Sub-acute inflammation, the glands alone 
being affected; pain shooting down the back or into the 
thigh, and changing suddenly. 

Haniaiuelis. Dull, heavy pain in testicle, at times excru- 
ciating. Scrotum hot, congested and swollen; the skin 
tense, smooth and shining. 

Aconite. Fever, hot dry skin, full pulse, great vascular 
excitement. 

Belladonna. Great sensitiveness of nervous system, 
with intolerance of pain, which is of neuralgic character. 

Clematis. Orchitis following chronic urethritis. 

Arnica. Conium. From contusion. 

GENERAL MEASURES. Absolute rest in bed— do 
not let patient rise even to relieve bladder or bowels. Sup- 
port testicle so as not to drag on cord. Apply hot Hania- 
melis fomentations. After inflammation has subsided, strap 
with adhesive plaster so as to make pressure. Relief of 
tension of tunica vaginalis promptly afforded by puncture, 
a straight, three-cornered surgical needle being passed 
through scrotum, and six or ten punctures being made in 
envelope of testis. 

HYDROCELE. 

REMEDIES. Iod., Cale. c, Sit.. Aurum, Puis., Bhod., 
Graph., Kali-hyd. 

Operative Treatment. In infants, acupuncture, causing 
the fluid to escape into areolar tissue of scrotum, often cures. 

Palliative treatment, for adults, evacuate contents of 
sac with aspirator or trocar. Method : — Make out position 
of testicle; grasp tumor firmly in left hand, with testicle 
occupying middle of palm. Plunge needle or trocar ob- 
liquely upwards and backwards into juncture of middle and 
lower thirds of hydrocele. 

Radical Cure. Tap hydrocede with small trocar, empty 
sac of all fluid and inject licpuid Carbolic acid, twenty to 
thirty minims, manipulating sac so as to bring acid into 
contact with entire surface, allowing acid to remain. Con- 
fine patient to room for forty-eight hours. 

" This method is followed by a radical cure in most cases, ami is un- 
attended by fever or other complications." Adams. 



142 



KEY NOTES OF MEDICAL PRACTICE. 



PAKT IV. 



MISCELLANEA. 



LEGAL MEDICINE. 

Expert Testimony. A physician is in law an expert 
as to all matters embraced within the range of his 
profession. It is not necessary that he be at the time in 
actual practice. It is not necessary that he should have 
made the particular disease involved in any inquiry, a 
specialty. But if he has devoted himself exclusively to one 
branch, and has had no experience in that subject to which 
he is called to testify, his testimony is inadmissible. A 
practicing physician whose knowledge of the particular 
subject of inquiry {e. g., insanity) was derived from study 
alone, has been held competent to express an opinion as an 
expert. Medical books are not admissible in evidence. 

An expert cannot be compelled to attend during the en- 
tire trial for the purpose of hearing all the testimony. 

The law is extremely conflicting us to whether profes- 
sional men can be compelled to testify as experts without 
extra compensation. In England it is settled that addi- 
tional compensation is required. In the United States the 
question is open, with the weight of authority in favor of 
the English rule. 

In the absence of any statutory provision to the contrary, 
it is well settled that a physician or surgeon may be com- 
pelled to disclose any communications made to him in pro- 
fessional confidence. This rule has been abrogated in 
several of the states by express statutes. 

" Physicians and surgeons shall b.e incompetent to testify as to infor- 
mation obtained in a professional capacity from a patient." Missouri. 

" No person duly authorized to practice physic or surgery shall be 
allowed or compelled to disclose any information which he may hav4 
acquired in attending any patient in his professional character, and 
which information was necessary to enable him to prescribe for such 
patient as a physician, or to do any act for him as a surgeon." MM 
York. 

Skill demanded. A physician's charge is more on ac- 
count of his skill and knowledge than of the time given to 
his patient's case. He is held to exercise ordinary care and 



LEGAL MEDICINE. 



143 



skill, but is not held to produce any benefit to the patient. 
The only defence against a suit for physician's service ren- 
dered on employment, is, first, as to the unreasonableness 
of the charges, or. second, actual malpractice. But a physi- 
cian must adhere to the system and the custom of the branch 
of the profession he has avowed. 

Collections. A physician has a right to demand and sue 
for reasonable charges for professional services rendered 
upon employment, either in advice or aid. 

Books of original entry only are received as evidence. A 
bill of items may be demanded by the debtor. 

When a patient receives, without objection, the services 
of an assistant, or a student, he is bound to the principal 
for the same. But where partners both attend a patient, 
they must recover in the firm's name. 

A bill for services rendered to a servant must be collected 
from him. unless the master expressly agrees to pay for the 
same. A minor may be held responsible for medical aid 
rendered him. 

Either the husband or wife, or both jointly, may be held 
for services rendered to one of the family. A city must 
pay for services rendered by a physician called by a police 
officer, if the case is urgent and the regular City Physi- 
cian and Surgeon is absent. 

Good-will. A physician may sell the " good-will ? ' of 
his practice, or his business, and may contract that he will 
not, within certain places and times, practice his profes- 
sion; but an agreement not to practice his profession at all 
is unlawful and cannot be enforced, because it is against 
public policy. 

Jurors. Practicing physicians are exempt from duty as 
jurors. 

Liability of Physician. A physician is liable for any 
damage caused by malpractice. He is also liable for all 
acts of an assistant or student done in the regular course 
of business. 

Malpractice. A physician or surgeon must bring to the 
performance of his duties as a professional man at least 
ordinary skill and knowledge, and must apply without mis- 
take what is settled in his profession; and must have the 
knowledge of the best and leading authorities in his science, 
down to the time the act is performed, or he is liable for 
damages that may accrue from his practice. 

Law Regulating the Pkactice of Medicine in the State 
of Illinois. 

Every person practicing medicine, if a graduate in med- 



1U 



KEY NOTES OF MEDICAL PRACTICE. 



icine, shall present his Diploma to the State Board of Health, 
for verification; if found to be genuine, the State Board of 
Health shall issue its Certificate to that effect, and such Di- 
ploma and such Certificate shall be conclusive as to the 
right of the lawful holder of the same to practice medicine 
in this State. If not a graduate, the person practicing med- 
icine in this State shall present himself before said Board 
and submit himself to such examinations as the said Board 
shall require, and if the examination be satisfactory to the 
Examiners, the said Board shall issue its Certificate in ac- 
cordance with the facts, and the lawful holder of such Cer- 
tificate shall he entitled to all the rights and privileges 
herein mentioned. 

Every person holding a Certificate shall have it recorded 
in the office of the Clerk of the County in which he resides. 
Any person removing to another County to practice, shall 
record the Certificate, in like manner, in the County to 
which he removes. 

The State Board of Health may refuse Certificates to 
individuals guilty of unprofessional or dishonorable con- 
duct, and they may revoke Certificates for like causes. 

Any person shall be regarded as practicing medicine, 
within the meaning of this Act, who shall profess publicly 
to be a physician, and to prescribe for the sick, or who shall 
append to his name the letters of " M. D." 

THE TEMPERAMEN TS. 

SANGUINE TEMPERAMENT. The form is full and 
round, neither very gross nor very spare, and the m uscles firm 
and elastic. The complexion is florid and ruddy, from the 
rich capillary circulation. Arterial blood abounds, the veins 
being small, the circulation active, and the pulse full and 
quick. The bodily functions are quickly and easily per- 
formed. Mind and body are quickly stimulated into action, 
and there is great endurfince. 

There is an intense animation and buoyancy of spirits, 
and in the mental sphere rapid thought, vivid imagination 
and quick perception. 

Subjects of this temperament are prone to congestions, 
inflammations and fevers, and all diseases are inclined to 
take on inflammatory action. 

Remedies. Aconite. Belladonna, Bryonia, Gelsemium, 
Veratrum vir. 

NERVOUS TEMPERAMENT. The habit is spare, the 
frame somewhat angular, the muscles spare, and not well de- 
fined. The skin is dark, dull, earthy, or sallow, and hot and 
pungent to the touch. The cranium is large. Thee ire utation 
is languid, with a preponderance of the venous system, the 



THE TEMPERAMENTS— INFANT DIET. 



145 



pulse variable and easily excited. The face has the linea- 
ments of energy, and movements are hasty and abrupt. 

The mental powers are large, and capable of persistent 
exercise. The affections are violent, and the sexual passions 
usually very strong. Sensations have an intensity far in 
excess of the exciting cause. 

The individual is subject to neuralgia, nervous diseases, 
spasmodic affections, and mental disorders. 

Remedies. Atropia, Ignatia, Coffea, Valerian, Mos- 
chus, Phosphorus, Zineum. 

LYMPHATIC TEMPERAMENT. The body is heavy, 
inclined to corpulence, the flesh full, but soft; the joints and 
hands large, and the feet broad and flat. Complexion sallow 
or pasty, the hair light or reddish. The pulse is slow and 
easily compressed. The bodily functions are slow and 
languid. The chest and heart are inadequate in bulk to 
the rest of the body. 

The mental processes are slow, though there is great 
firmness and constancy, and usually good judgment. 

These subjects are inclined to glandular enlargements, 
catarrhal affections, abscesses and dropsies. There is slight 
power of resistance to acute diseases, with a tendency to 
take on the chronic form, especially of the strumous and 
asthenic kinds. 

Remedies:. Arsenicum. Iodine, Calcarea, Hepar s., 
Mercurius, Sejiia, Silica, Sulphur. 

BILIOUS TEMPERAMENT. Habit spare: muscles 
hard-knit; tendons wiry, complexion swarthy, with a yellow- 
ish tinge; sharp features; dark and deep-set eyes. They are 
characterized by violence of reaction to irritation, particu- 
larly of the biliary apparatus, with disturbances of the 
digestive functions, dark-colored urine, and constipation. 
The bilious derangement engenders melancholy, ill-humor 
and acrimony of temper. 

Remedies. Nux vom., Chamomilla, Bryonia, Sulphur, 
Podophyllum, Aloes. 

INFANT DIET. 
In order to prepare cow's-milk so as to adapt it to the 
wants of the infant organism, it must be diluted by the ad- 
dition of a mucilaginous liquid, such as gum-Arabic-water, 
barley-water, gelatine, or oat-meal-water, some lime-water, 
sugar, and a little salt, in about the following proportions: 
Oatmeal-water, - - 2 tablespoonfuls; 
Lime-water, - - - 1 tablespoonful; 
Fresh milk, - - - 3 tablespoonfuls; 
Sugar-of-milk, - - - 1 teaspoonful; . 
Salt, . - - - a pinch. 
This is sufficient for one feeding. Prepare it fresh as 
wanted. 



146 



KEY NOTES OF MEDICAL PRACTICE. 



Oatmeal- water. Soak a teacupful of oatmeal in a 
pint of water, with a little salt added, over night. Strain 
thoroughly, through a napkin, next morning. 

Barley-water. Take a teacupful of pearl-barley, and 
soak it for half an hour in a little luke-warm water, p?evi- 
ously salted. Drain off the water, pour the barley into a 
pint of boiling water, and let it simmer one-half hour; when 
done, strain into a pitcher. 

Gum-Arabic- water. Dissolve pure gum-Arabic in 
water, one part to ten, by bulk. 

For very young babes, use the gum-Arabic water, in the 
proportion above given; for older children, barley-water if 
the bowels are loose, oatmeal-water if there be constipa- 
tion. A little gelatine added to the mixture of milk and 
water, may be substituted for any of the above. 

DIET IN CHOLERA-I XF A NTUM . 

Keep the child cool, let it have plenty of fresh air, and 
let it have no food in which the process of fermentation has 
begun. Avoid starchy foods. 

The milk-and-barley-water, prepared as above, may be 
all-sufficient. Keep litmus paper on hand, and test the 
milk frequently; if it show any acidity, reject it. 

Albumen-water. Gently stir the whites of two eggs 
into a half-pint of cold water, and sweeten with a little 
sugar-of-milk. 

This is the most simple food that it is possible to obtain, 
and may be resorted to when all others fail. 

Wine-whey. Heat a pint of fresh milk to the boiling 
point; add slowly a wineglassful of sherry wine, and let it 
gently simmer until the curd forms. Strain the whey 
through a cloth, and sweeten. This is nourishing and stim- 
ulating." 

DIET IN FEVERS. 

Give no solid food to a fever-patient. Let all food be 
simple but nutritious. Give food at frequent intervals and 
in small quantities. Food for fever-patients should be fluid 
in form, easy of digestion, and highly nutritious. Those 
who have been properly nourished make the best recov- 
eries. In typhoid, and diseases in which the bowels have 
been affected, no solid food must be given until the stools 
are again consistent and fecal. 

Milk is the best food that can be given. So long as the 
patient can take it, none other need be sought for. 



DIET IN FEVERS— RECTAL ALIMENTATION. 147 



Beef-tea, in the stage of depression, is useful as a stim- 
ulant. 

Recipe. Take one pound of fresh meat, cut very fine, 
soak in one-third of a quart of cold water over night. In 
the morning remove the meat, saving the water in which it 
has soaked. Put the meat in two-thirds of a quart of water, 
and let it simmer for two hours, keeping the water up to 
its original level by replacing what is lost by evaporation. 
Now pour the beef-broth into the cold liquor in which the 
meat was soaked, squeezing the meat as dry as possible. 
The meat which remains should be spread on a tin plate, 
and dried in an oven. When perfectly dry it can be easily 
reduced to a powder in a mortar. Mix this meat-powder 
in the liquor, and you have all the elements of the meat in 
a fluid form. Salt to taste, and add twenty drops of Muri 
atic acid and three grains of Pepsin. 

This is the only preparation of beaf-tea which contains 
all the elements of the meat. 

Rules for making Beef-tea. Never let beef-tea boil. 
Alwaj's begin with cold water. Cut the meat very fine, and 
remove all fat, gristle and bones. The proper proportion 
is a pound to a pint. After making, carefully remove all 
traces of fat. To warm up beef-tea, put it in a bowl, and 
set the bowl in a vessel of hot water. 

Egg-nog. One egg; one glass of milk; one dessert- 
spoonful of brandy; one dessertspoonful of sugar. 

Carefully scald the milk, and let it afterwards become 
cold. Beat the sugar and egg up together to a froth, put 
into a glass, add the brandy and fill up with the milk. If 
wanted in a hurry, the milk may be used without scalding. 

Mutton-broth. Take a pound of fresh mutton, free 
from fat; cut into thin slices with a sharp knife; put into a 
suitable dish, salt, pour over it a quart of cold water and 
let it simmer over a slow fire for an hour — then let it boil 
for an hour longer. Strain off the broth, refusing the meat 
fibre. Season with salt. 

RECTAL ALIMENTATION. 

Preparatory to giving an enema, empty and wash the 
rectum by giving an injection of clean, warm water. 

Force the enema in slowly. 

Throw it as high up as possible. 

Inject at intervals of two hours. 

Inject no more than half a teacupful at a time. 

Let the enema have a temperature of about that of the 
body— 98° or 100° F. 



148 



KEY NOTES OP MEDICAL PRACTICE. 



Warm-milk, with a little salt in it, makes a simple and 
readily-absorbed enema. Heat the milk to the proper tem- 
perature, inject every two hours, and the patient is getting 
considerable nourishment. 

Beef-tea. made according to the recipe given, makes a 
very nutritious enema. The pepsin and muriatic acid are 
necessary to fit it for absorption. 

Cod-liver-oil. Chop fine a half-pound of beef -pancreas, 
cover this with water and allow it to stand for an hour in a 
warm place. Strain through a cloth. Mix an ounce of this 
pancreas solution in a half-ounce of Cod-liver-oil, and use 
as an injection in those cases in which it is desired to sup- 
ply the system with fat. 

NUTRIENT SUPPOSITORIES. 

Take a quantity of the whole-beef-tea, set the basin con- 
taining it in another vessel of hot water, and evaporate the 
water from the beef-tea until it becomes of a creamy con- 
sistence. Now add an equal quantity of Cacao-butter, melt 
both together, pour into a dish and allow the mixture to 
cool and solidify. With a warm knife cut into bits, and 
shape like a pigeon's egg. These nutrient suppositories 
introduced into the rectum at frequent intervals, will afford 
nourishment to the system in the neatest and cleanest way 
in which artificial alimentation can be practiced. 

MILK DIET. 

Diabetes, Blight's disease, Dyspepsia, and some other 
diseases, undergo great improvement on an exclusive milk 
diet. The following rules will aid in carrying out this treat- 
ment. 

Use fresh milk. The milk may betaken cold or warm, 
but it must not be boiled in the warming. 

The first day take from four to six pints. This would be 
from two to three glassfuls taken every two hours during 
the day. 

It is better to divide the day into equal periods and take 
frequent draughts — even though a glassful be taken every 
hour — than to take a large quantity on the stomach at once. 

The quantity of milk should be increased from day to day 
until five or six quarts are taken daily. This quantity, six 
quarts, need not be exceeded. 

In Diabetes, nothing else must be taken while the milk 
diet is used. If at the end of a week there is no improve- 
ment, the treatment may be abandoned. If the treatment 
be of benefit it will be denoted by a diminished amount of 



POULTICES. 



149 



urine, less sugar, and improvement in the general health. 
It should be continued from three to six weeks after all 
sugar has disappeared from the urine. 



POULTICES. 

Cataplasms are local baths they supply heat and mois- 
ture to a part, soften the cuticle, relax the skin, dilate the 
vessels, lessen tension and relieve pain. 

Use in — Pneumonia, Pleurisy. Bronchitis. Pericarditis, 
Peritonitis, other internal inflammations, Rheumatism. 
Lumbago, and to mature Abscesses. 

Rules. Do not remove one poultice till next is ready to 
replace it. A poultice should be applied as hot as it can be 
borne. Change a poultice every two or three hours by day, 
every four hours at night. To make a poultice retain heat 
longer, cover with oil-silk or cotton-wool. Peritonitis 
requires a thin poultice; cover with cotton-wool. In sup- 
purations, do not let poultice be larger than the abcess it is 
intended to cover. 

Linseed-meal. Put sufficient hot water into a hot bowl, 
sprinkle the meal into the water, stirring vigorously until 
the required consistency is attained, and lastly stir in a 
small quantity of olive oil. Spread smoothly and evenly 
on a piece of muslin, and cover with piece of cheese-cloth. 
Oatmeal poultices may be jn-epared in a similar manner. 

Starch. Add a little cold water to the starch, and blend 
the two into a pap; then add sufficient boiling water to 
bring it to the required consistence, and spread on cloth. 
This is neat, bland and unirritating. 

Disinfecting poultice. Anoint the part with Carbolic 
oil (1 to 10) and apply a pad of carded oakum, wrung out 
of hot water. 

Fly-blister. Spread a thin layer of Cantharides Cerate 
on piece of brown paper, soft leather, or, preferably, a 
piece of adhesive plaster. Leave fj-ee margin around the 
salve. Moisten skin with vinegar, cover surface of plaster 
with tissue-paper moistened with vinegar, apply and secure 
by adhesive straps. From two to twelve hours minimum 
and maximum time to leave plaster on. 

Cantharidal collodion. Dissolve gun-cotton in an 
ethereal solution of Cantharides. Apply by means of 
camel's-hair pencil. This makes a very effectual and easily- 
regulated vesicant. 

Mustard-poultice. Mix some linseed-meal in a quan- 
tity of boiling water, to creamy consistence, then add same 



150 



KEY NOTES OF MEDICAL PRACTICE. 



quantity of mustard as of meal used, stirring constantly. 
Spread on a cloth, cover with gauze, and apply. 

A mustard poultice should remain from ten minutes to 
half an hour, according to strength. Indicated when mild 
and rapid counter-irritation is required. 

MOIST FOMENTATIONS. 

Used to relax spasm, as intestinal, renal and biliary colic. 

Directions. Place a fold of flannel cloth in the middle 
of a towel, twist the ends of the towel, and dip the portion 
containing the flannel into boiling water, take out and 
wi'ing it until as much water as possible is pressed away. 
Take out the flannel and apply to the painful part. Or, 
sprinkle a fold of flannel with warm water, and run a very 
hot flat-iron over it. Compresses lose their heat rapidly, 
and must be frequently renewed. 

Turpentine Stupe. If slight counter-irritation be de- 
sired, sprinkle the fomentation with turpentine. 

Poppy-fomentation. Sprinkle the fomentation with 
Laudanum, if sedative action be desired. 

DRY FOMENTATIONS. 

When dry heat is required, put into a flannel or muslin 
bag, of suitable size, a quantity of hot sand, hot salt, hot 
bran or hot corn-meal. A hot plate, wrapped in a cloth, 
answers well. A rubber-bag filled with hot water is the 
most perfect. Put Acetate of Soda into a tin can, tightly- 
closed, of suitable shape; set this in boiling water for thirty 
minutes; remove, wrap in flannel and apply to painful part. 
It will give off heat for many hours. 

COLD APPLICATIONS. 

Ice-bags. Put pounded ice, with a little water, into a 
bladder or rubber bag, filling it only half full. Use for 
refrigeration and to contract the vessels and reduce con- 
gestion, especially in inflammation of the brain. 

Cold cloth. Cloths may be simply wrung out of cold 
water, or, put some salt and pounded ice into a tin basin, 
set this on a wet cloth, stir, and the cloth beneath may be 
quickly frozen to any required degree. 

Cold drip. Stand a vessel of cold water on a table 
higher than the patient's bed, put one end of a long strip 



BATHS. 



151 



of lamp-wick into the water, and lay the other across a cold 
cloth which is applied to the inflamed part. A continuous 
stream of cold water is thus conveyed to the part, and the 
water which passes from it must be caught in a basin on 
the other side. 

Cold cap. Stitch onto a muslin 
cap, made to fit the head, a coil of 
' rubber tubing, arranged spirally, 
with the two ends free. Wet the 
cap, and put it on the head, then 
place one free end in a bucket of 
cold water, suspended at a height, 
and the other in another bucket on 
the floor. Let the water syphon 
from the upper to the lower bucket. 
When the upper one becomes 
empty, reverse their relative po- 
sitions. 

This is a very efficient method of 
refrigerating the head in cerebro- 
spinal meningitis, and in " brain-fever," when it is desired 
to apply continuous cold. 

BATHS. 

Temperature of Baths. 
Cold - 50°— 60" Fahrenheit. 

Temperate ... 75° — 85° 
Tepid - 85°— 95° " 

Warm ... - 95 — 98° 
Hot 98°— 110° 

Bran bath. Boil four pounds of bran in one gallon of 
water, strain, and add the liquor to sufficient water for a 
bath. Use to allay irritability of skin, and to soften it in 
squamous diseases. 

Salt bath. Add rock-salt in the proportion of one 
pound to four gallons of water. Used as an invigorating 
bath, and to lessen susceptibility to cold. 

Alcohol bath. An ounce of Alcohol to the quart of 
water. Use for same purpose as salt-bath. 

Sulphur bath. Twenty grains of Sulphuret of Potas^ 
sium to a gallon of water. For skin-diseases and rheu- 
matism. 

Mustard bath. Add a handful of mustard to the ordi- 
nary hot bath, or a smaller quantity to a foot-bath. Use 
when stimulating action is required. 




152 



KEY NOTES OF MEDICAL PRACTICE. 



Cold douche. Lower patient's head, place rubber-cloth 
under, and pour cold water from a pitcher over crown of 
head, the pitcher being slowly and gradually raised higher 
and higher, so that the water may fall with more force. 
Used in sun-stroke, and intense cerebral congestion. 

Wet pack. Spread a comfort and several blankets on 
the bed, and over these a sheet wrung out of cold water. 
Remove all of the patient's clothing, lay him in middle of 
sheet, draw the edges of sheet over, and wrap the patient 
in it snugly, then draw over one side after another of 
blankets and comfort, and make all snug. Put cold wet 
compress on forehead. 

Used to reduce temperature in typhoid, and to develop 
delayed eruption in scarlet, and other specific fevers. 

"It develops the rash, greatly reduces the fever, quiets the pulse, 
renders the skin moist and comfortable, and abates the restlessness 
and wandering." Ringer. 

Vapor bath. Improvised. Place patient, with clothing 
removed, in large, cane-seated chair, and surround both 
completely with blankets, letting them extend to the floor, 
and be secured about patient's neck. Under the chair place 
basin of hot water, with alcohol-lamp beneath it; bring water 
to a boil, and patient will soon be brought into state of per- 
spiration which may be carried to any desired extent. Use 
in Uraemia, Bright's disease, and whenever diaphoresis is 
required. 

Mercurial bath. Given as above, by adding a metal 
plate, with lamp beneath, on which is put 60 to 180 grains 
bi-sulphuret of Mercury. Used sometimes in treatment of 
secondary syphilis. 

DISINFECTANTS. 

To purify the atmosphere of a sick-room, nothing equals 
an abundance of pure, fresh air. 

To ventilate a room, and at same time avoid a draft, 
raise the lower sash, and shut it down onto a folded blanket 
placed beneath it, leaving an aperture of several inches 
between lower edge of upper, and upper edge of lower 
sash. 

For Air of sick-room. 1J . Potassii permanganate, 3j{ 
Acid Oxalici, "j, mix, and moisten with twice the quantity 
(by bulk) of water; in two hours add a small quantity more 
of water. This will emit ozone freely enough for a large 
room, and it is an active disinfectant. 

For drinking-water. Add sufficient permanganate of 
potassium to render it slightly pinkish in a strong light, 
then filter. 



DISINFECTANTS. J53 

For Water-closets, Vessels and Drain-pipes. 

Hot water, 2% gallons; 

Copperas. 4. pounds; 

Carbolic acid, - ... 4 pounds. 

In typhoid fever, dysentery, etc., keep it in vessels, and 
pour it down water-closet freely. 

For Drains. Ditches and Sewers. Disinfect with 
Chloride-of-lirne: — one pound is sufficient for one thousand 
gallons of running sewage. 

For heaps of filth. Cover with Charcoal, two or three 
inches deep, or with dry earth. 

For Washing Clothing. 

Sulphate of Zinc, - - - 2 1 -o ounces; 

Carbolic acid, - - - - - 1 ounce; 
Hot water, ----- 1 gallon. 
Soak the clothes twelve hours, then wash. Use in cases 
of Erysipelas, Small-pox, etc. 

Fumigation after Contagious Diseases. With Sulph itr, 
only practical method. Heavy clothing, blankets, etc., to 
be disinfected, should be opened and exposed. Close the 
room as tightly as possible; stuff all cracks and paste paper 
over key-holes. Place the Sulphur in iron pans set on 
bricks, in wash-tubs containing a little water. Ignite 
it by aid of hot coals, or, a spoonful of alcohol poured 
over it and ignited with a match. Hasten from the room 
and keep it closed for twenty-four hours, then open win- 
dows wide and air it thoroughly. For a room ten feet 
square, use two pounds of Sulphur, and for larger ones a 
proportionate quantity. 

Airy, well-ventilated sleeping apartments are of the 
utmost importance for the sick. The sick-room should also 
have such an exposure that it may receive, several hours of 
each day, the direct sun-light. 

To prepare chromicised cat-gut: — One part of chromic 
acid is first added to five of water. One part of the solu- 
tion thus made is then mixed with five of glycerine. Steep 
the gut in this for a week and it will be capable of resisting 
the action of the tissues for a fortnight. 



154 



KE\ NOTES OF MEDICAL PRACTICE. 



MICROSCOPICAL EXAMINATION OF THE 
URINE. 

1. Sediment in the urine has no significance unless de- 
posited within twenty-four hours. 

2. Albumen in the urine does not indicate kidney-disease 
unless accompanied by tube-casts. The most fatal form of 
Bright's disease (contracted kidney) has little or no albu- 
men. 

3. Every ivhite crystal in urine, regardless of shape, is a 
2)hosphate, (except the oxalate of lime, which has its own 
peculiar form) when the urine is alkaline. 

4. Every yellow crystal is uric acid if the urine is acid, or 
a urate if the urine is alkaline. 

5. Mucous casts, pus and epithelium signify disease of 
the bladder (cystitis), or of other parts of the urinary tract, 
as determined by the variety of epWielium. 

6. The urine of females can often be differentiated from 
that of males, by finding in it the tessellafed epithelium of 
the vagina. 

7. Hyaline casts (narrow), blood and epithelial casts, sig- 
nify acute catarrhal nephritis. Much albumen. 

8. Broad hyaline casts, and epithelial, dark granular, and 
oil casts, signify chronic catarrhal nephritis. At first, much 
albumen; later, less. 

9. Hyaline and pale granular casts and little or no albu- 
men signify interstitial nephritis. 

10. Broader casts are worse than narrow casts, as far as 
diagnosis is concerned, for the former signify a chronic 
disease. 

11. The urine should be fresh 'for microscopical examina- 
tion, as the micrococci will change hyaline casts into gran- 
ular casts, or devour them entirely, in a short time. 

12. Trommer's- test should never be trusted to alone, if the 
amount of sugar is small. 

" The microscope gives better ideas of the exact condition of affairs 
in the examination of urine than the various chemical tests." Dr. 
Formad. 



156 



KEY NOTES OF MEDICAL PRACTICE. 



TIRINA LYSIS. 



Albumen. 



Render urine slightly acid — if 
not already so — by Acetic or 
Nitric acid; boil, and add one- 
tenth bulk Nitric acid. 



A white, cloudy 
deposit on boiling, 
which remains after 
addition of the arid 

--Albumen. 



Blood. 



Heat the urine, then add 
caustic potash and-fteai it again. 



A dirty, yellowisli- 
red sediment, blood- 
red color by trans- 
mitted light— Blood. 



Pus. 



Let urine stand till sediment 
deposits — pour off super-natant 
fluid — add to remaining sedi- 
ment equal volume liquor 
Ijotassa:. 



Mix well, and a 
viscid, gelatinous 
mass, which pours 
like white of egg= 
Pus. 



Mucus. 



Add to freshly-voided urine, 
some Acetic acid ; if considerable 
turbidity appear, add Hydro- 
chloric acid. 



If turbidity disap- 
pear, the urine be- 
coming clear on ad- 
dition of the Hcl,= 

Mucus. 



Bile. 



Place small quanity urine and 
a few drops of red, " fuming " 
Nitric acid side by side on por- 
celain dish, and allow them to 
gradually intermingle. 



A play of colors- 
green, blue, violet, 
red, and yellow or 
brown ^ Bile. 



Sugar. 



Add to urine few drops solu- 
tion Cupric sulphate, then its 
own volume liquor potassa', and 
boil. (Albumen must be absent). 



A precipitate of 
brick -dust-like sedi- 
ment=Sw£rar. 



I Take two specimens — to one 
i add a bit of yeast; set side by 
Suffar si( l (J for twenty-four hours in 

temp, of 75° to 80° F., then take 
| specific gravity of each. 



If specimen which 
contained the yeast 
has lower sp. gr. 
than other ^Sngar. 



Urea. 



Take equal parts 
Nitric' acid, mix in 
and set aside. 



urine and 
I test-tube 



Crystals of nitr 
of urea — visible 
naked eye — indie 
excess of Urea. 



_ T . . . . Take urine q. s., add Hydro- 

I riC Acid. chloric avid one-eighth part; set 
I aside for twenty-four hours. 



A precipitate 
square crysta 



. • Boil the urine; if there is a 

Phosphates, cloudy deposit, add one-tenth 
j part Nitric acid. 



If the urine clears 
up on addition of the 
acid Phosphates. 



Chlorides. 



Slightly acidulate urine with' r ,., mTW ^uonra. 
Nitric acid, and add few drops • ) ump5 ?, P , f 
solution Nitrate or Silver. I cl P«t«te ^Chlorides. 



VITAL CAPACITY. I57 

VITAL CAPACITY. 

Definition. The capacity of the lungs, in cubic inches 
of air, as measured by the spirometer. 

The vital capacity varies according to sex, height, weight, 
age, and disease. 

Sex. The vital capacity of man exceeds that of woman, 
of same height, by about 38 inches. 

Height. There is an increase of 8 cubic inches in vital 
capacity for every inch in height between 5 feet and 6 feet. 

Weight. Excess in body-weight is associated with 
diminished capacity in the proportion of about one cubic 
inch per pound excess. 

Age. From thirty to sixty years the vital capacity 
decreases nearly l}.^ cubic inches per year. 

Disease. In lung-diseases the vital capacity is always 
diminished, and bears a certain relation to the extent of 
the lesion. 

TABLE 



GIVING VITAL CAPACITY OF MALES AND FEMALES, AT DIFFERENT 
HEIGHTS. 



FEET. 


INCHES. 


M. 


F. 


FEET. 


INCHES. 


M. 


F. 


4 - 




- 126 - 


- 88 


5 - 


- - i - . 


- 198 - 


- 160 


4 - 


- 8 - 


- 134 


- 96 


5 


- 5 - 


- 206 


- 168 


4 - 


- - 9 - - 


- 142 - 


- 104 


5 - 


- - 6 - - 


- 214 


- 170 


4 - 


- 10 - 


- 150 


- 112 


5 - 


7 


222 


- 184 


4 - 


- 11 - - 


- 158 - 


- 120 


5 - 


- - 8 - - 


- 230 - 


- 192 


5 


- 0 - 


- 166 


- 128 


5 - 


- 9 - 


- 238 


- 200 


5 - 


. . 1 . . 


- 174 - 


- 136 




- 10 - - 


- 246 - 


- 208 


5 - 


2 


- 182 


- 144 


5 - 


- 11 - 


- 254 


- 216 


5 - 


- - 3 - - 


- 190 - 


- 152 


6 - 


- - 0 - - 


- 262 - 


- 224 



Of twelve phthisical patients examined, those who had 
lost over three-tenths of their vital capacity, only three 
lived longer than four months, as shown hy the following 



table: 












PATIENT. 


LOST. 


SURVIVED. 


PATIENT. 


LOST. 


SURVIVED. 


No. 1 - - 


- 4-10 - 


- - 12 ds. 


No. 7 - - 


- 4-10 - 


- - 4 ms. 


" 2 


- 5-10 - 


- - 8 ms. 


" 8 - 


- 3-10 


- - - 8 " 


" 3 - - 


- 4-10 - 


- - 2 " 


" 9 - - 


- 3-10 - 


- - 4 " 


" 4 - 


- 2-10 - 


- - 6 " 


" 10 - 


3-10 


. - - 3 " 


5 - - 


- 4-10 - 


- - 2wks. 


" 11 - - 


- 3-10 - 


- - 2 " 


" 6 - 


- 6-10 - 


- - 2 " 


" 12 - 


- 3-10 


- - - 3 " 



Phthisis. To examine sputum for elastic fibres, mix it 
with soda solution ( 1$ Liquor Sodce, Zj, Aqua, ;ij. M.) and 
boil five minutes. Then dilute with equal quantity distilled 
water, and pour into a flat porcelain vessel. The particles 
suspended in the water may be taken out and examined 
under a microscope. The fibres are brown, slightly reticu- 
lated, and a fraction of a millimetre in length. 



158 KEY NOTES OF MEDICAL PRACTICE. 

ARRANGEMENT OF THE TEETH; 



Temporary Teeth. 



g o m o S 
^ Upper Jaw 2 14 1 2=10j 

(Lower Jaw 2 14 1 2=10 ) 



S p o 5 o P S 
( Upper Jaw 3 2 1 4 1 2 3=16 ) I 

Permanent Teeth. < — ■ f 32 1 

( Lower Jaw 3 2 1 4 1 2 3=16 ) } 

PERIODS OF ERUPTION OF THE TEETH. 

Temporary Teeth. 

6th or 7th month, two middle incisors. 
9th " two lateral incisors. 
12th " first molars. 
18th " canines. 
24th " two last molars. 

Permanent Teeth. 

6th or 7th year, the four anterior or first molars. 
7th " two middle incisors. 
8th " two lateral incisors. 
!)th " first bicuspids. 
10th " second bicuspids. 
11th to 12th " canines. 
12th to 14th " second molars. 
17th to 21st " last molars or "wisdom teeth." 
Early closing of the fontanelles indicates early dentition, 
and vice versa. 

The teeth of rachitic children are about one month late. 
The "wisdom teeth" are the last to come and the first 
to go. 

Children have been born with teeth (N. Y. Med. Jour., V. 
xxii., p. 444). Richard III. is said to have been born with 
teeth. Cases are recorded where adults never cut teeth 
(Boston Med. Jour., Mar. 6, 1879, p. 183). A man said to 
be over one hundred years old, cut a complete front set of 
teeth (German " Ephemerides," dec. ij. ann. 3, p. 57). Com- 
plete third sets have been cut. 



TEMPERATURE— HYPODERMIC MEDICATION. 159 



TEMPERATURE. 

1° Centigrade — 1.8° Fahrenheit. 
Rule. To convert Centigrade into Fahrenheit, multiply 
by 1.8 and add 32. 

Example: 37 C. X 1.8+32=98.6 F. 

Rule. To convert Fahrenheit into Centigrade, deduct 
32 and divide by 1.8. 

Example: 104°F.— 32-Hl.8=40 C. 



ECIITIVAL.EXTS. 



F. 


C. 


F. 


C. 


F. 


C. 


97.0° 


=36.1° 


100* 


=37.7° 


104 : 


= 40.0 


98.0 


=36.6° 


101° 


=38.3" 


105 c 


= 40.5° 


98.6' 


= 37.0° 


102° 


=38.8° 


106 


=41. r 


99.0 


=37.2° 


103° 


=39.4° 


107 : 


=41.6° 



An increase of one degree Fah. above 98° corresponds 
with an increase of ten beats of the pulse per minute. 

If, in the first week of a supposed case of typhoid, the 
temperature fall to normal, for however short a space of 
time, it is not typhoid. 

Average temperature in health, 98.6° F. ^37 °C). In rec- 
tum and vagina it is 0.9° to 1.3 3 F. higher. The daily range 
rarely exceeds 1.8 3 F. (1°C.) above or below the average. 
The axillary temperature may fall to 97°F. without col- 
lapse, or rise to 100 'F. without fever. 

" In an instance of injury to the spine after a fall, reported by Mr. 
Tealeto the Clinical Society {London, Lancet, March, 1875), the young 
lady lived, though the temperature reached above 122°, and ranged 
for days between 112° and 114° F." Da Costa. 



HYPODERMIC MEDICATION. 

Select for injection, flexor side of arm, over biceps 
muscle, or abdomen, near umbilicus. Pinch up fold of 
integument between thumb and forefinger, insert point of 
needle well beneath integument, inject slowly, withdraw 
carefully. As rule, not more than one-half usual dose, as 
given by the mouth, should be injected. 

TABLE OF DOSES. 

Muriate of Morphine, - - - - V* to 'i of a grain. 

Sulphate of Morphine, - - - % to 'j of a grain. 
Sulphate of Atropine, - 1-120 to 1 30 of a grain. 

Strychnine, ------ 1-120 . to 1-30 of a grain. 

Sulphate of Soda, - - - - - 2 grains.- 

Sulphate of Quinine, - - - - 2 to i grains. 

Squibb's liquor of Opium, - - - 5 to 40 drops. 
Magendie's solution, - - - 3 to 20 " 

Tincture Hyoscyamus, - - - - 10 to 20 " 

Tincture Cannabis, - - - - 10 to 20 " 

Ergot, Fl. Ext., - - - - - - 15 to 30 " 



160 



KEY NOTES OF MEDICAL PRACTICE. 



Test for Chloroform. When equal parts of Purified 
Chloroform and colorless, concentrated Sulphuric Acid are 
shaken together in a glass-stoppered vial, there should be 
no color imparted to either liquid, or but a faint tinge of 
color imparted to the acid after twelve hours' standing; 
neither should there be any sensible heat developed at the 
time of mixing. 

Chloroform, as it evaporates from bibulous paper, should 
give but little foreign odor, and the paper should be left 
odorless after evaporation. Chloroform should not be 
used for inhalation without having been subjected to these 
tests. 

Iodoform. To destroy the oflor of, add three grains of 
Cumarin to a drachm of Iodoform. Mixing Iodoform 
with peppermint-oil also masks its odor. 

Rubini's Camphor. Equal parts by weight of Camphoi 
and spirits of wine, 60 degrees over proof. The spirits 
will dissolve and hold in solution its own weight of camphor. 

Ice. To keep in sick-room, 
tie a piece of flannel loosely 
over the mouth of a bowl, put 
the pounded ice in the nest 
formed by the depression as the 
cloth hangs down in the bowl, 
and cover with another piece 
of same material. In this way 
it will last throughout a warm 
night. Break bits off. as want- 
ed, with a pin. 

HARDENING BANDAGES. 

Starch Paste. Starch is stirred in cold water to a uni- 
form, cream-like consistence, and then, constantly stirring, 
boiling water added to produce a clear, thickish mucilage. 

Starch Bandages are made by drawing through thiB 
paste ordinary roller-bandages, of strips of muslin. 

Starch Splints. Draw strips of paste-board once 
quickly through hot water, then thickly smear both sides 
with the paste. 

Application. Pad recesses about joints with cotton- 
wool, apply moist flannel roller, lay starch splints over this, 
and then bandage with starch roller. Envelop whole with 
dry roller bandage. 

Plaster-of-PariS. Mix in porcelain dish, constantly 
stirring, pouring on sufficient water to make paste consist- 




WJDIUJUTS AND MEASURES— SIGNS OF DEATH. 161 



ence of thick cream. It stiffens in five to ten minutes. To 
delay setting, add more water, or powdered borax; to 
hasten, use hot water, or add common salt. 

Application. Cover limb with dry roller bandage, then 
apply plaster bandage over this. 



WEIGHTS AXD MEASURES. 

To learn to write prescriptions, in terms of Grammes, is 
really a very easy matter indeed, it being only necessary to 
bear in mind the following approximate 

EQUIVALENTS : 

1 Grain (gr.) equals .06 Gramme (Gm.); 

1 Drachm {') equals 4. Grammes (Gm.); 

1 Ounce (3) equals SO. Grammes (Gm.); hence, 
To convert Grains (or M.) into Grammes, multiply by .06; 
To convert Drachms (or f") into Grammes, multiply by 4; 
To convert Ounces (or f§) into Grammes, multiply by 30.* 
N. B. Use an upright line in the decimal place. 



Thymol, - 
Iodoform, 
Calamine, 
Starch, 

Mix. 



EXAMPLES : 

IODOFORM POWDER. 

- - - (mj) - 
(grs. xxx.) 

I ■ " 



Gm. 

I 06 
1 I 80 
4 I 
30 



BROMIDIA. 



Ij!. Ext. Cannabis Ind., 
Ext. Hyosciami, 
Brom. Potass., - 
Chloral Hyd., 
Syrup simpl., 
Aqua pura., - 

Misce. 



aa (grs. iij.) 

aa (3vj) 
W - 
Hi) - 



Gm. 



24 
30 
60 



18 



SIGNS OF DEATH. 

1. The entire and continuous cessation of the heart's 
action. This must be tested by a practiced ear, using the 
stethoscope. Or, tie a ligature tightly about a finger: the 
part beyond the constriction will, if there be circulation 
become bluish-red, while, where the ligature is applied 

♦More accurately, .065 (.06); 3.9 (4); 31.1 (30). 
6 



162 



KEY NOTES OF MEDICAL PKACTICE. 



there will appear a narrow white band. If, during life, a 
little Ammonia solution be injected subcutaneously, a port- 
wine congestion is set up in the surrounding parts: no such 
redness results when the operation is performed on a dead 
body. 

2. The entire and continuous cessation of respiration. 
Test by the surface of a cold mirror held over the mouth: if 
moisture condense, breathing has not ceased. Hold a light 
feather over the lips, to see if there be a current of air pass- 
ing. Set a glass of water on the chest — motion, if present, 
will be indicated by the images of surrounding objects 
reflected from the surface of the water. 

Six hours after cessation of signs of life, if the muscles 
do not respond to a strong electrical current, life is cer- 
tainly extinct. 

ARTIFICIAL RESPIRATION. 

To be resorted to in all cases of suspended animation if 
the respirations fall below ten to the minute. 

Remove all clothing from chest and arms. Clear mouth 
of mucus. Patient on back, with small, firm cushion, or 
roll of clothing, under shoulders. Pull tongue forward 
and secure it by string tied over tongue and under chin. 




Stand or kneel behind and at head of patient. Grasp the 
arms just above the elbows, and draw them gently and 
steadily outwards, upwards and backwards, till they meet 
above the head, keeping them in that position for two 
seconds. 




Then, flex the arms at the elbows and return them 
slowly to the sides of the chest, and press the arms firmly 



TRANSFUSION. 



163 



against the chest, holding them there for two seconds. 
Repeat this process at the rate Of fifteen ot eighteen times a 
minute. When spontaneous respiration has become re- 
established, cease further effort, and proceed to induce cir- 
culation and warmth. 

In changing operators do not miss a single movement. 
Occasionally blow a little of the vapor of Ammonia, or a 
little snuff, into nostrils. Persevere in this treatment for 
hours. 

After breathing has been restored, promote warmth by 
rubbing limbs upwards, with firm, grasping pressure, and 
energy, using flannels, handkerchiefs, etc. Continue the 
friction under the blankets, or over dry clothing. Pro- 
mote warmth by application of hot bottles, hot bricks, 
bladders of warm water, etc.. to pit of stomach, armpits, 
between the thighs, to soles of feet. Provide at all times 
for free supply of fresh air. 

As soon as patient can swallow, give hot water, by tea- 
spoonful, and follow it by wine, diluted brandy, or coffee. 
Put him in a warm bed, and encourage a disposition to 
sleep. 

TKAXSFVSIOX. 

To support patient until transfusion can be performed — 
Keep head low; raise the limbs; make friction from distal 
end towards the body, and then apply snug bandage about 
the limbs, near to body, Maintain warmth. 

The object to be attained is to fill the blood-vessels, and 
get up vascular tension, so that the heart will have something 
to contract upon. For this purpose use the 

Solution of Schwartz: 

IjJ. Distilled water, 100° F., - 2 pints; 

Common Salt, - - drachms; 
Liquor Sodae, - - 20 drops. Mix. 

Select median basilic vein at elbow, or internal saphenous, 
in front of internal malleolus. The collapsed vein is some- 
times hard to find — cut down onto it, expose it freely, and 
pass two ligatures under it. With one ligature, tie the 
vein at the exposed portion which is nearest the hand or 
foot; push the other ligature to the other end of the 
wound. 

Open the vein by raising the upper wall with a fine pair 
of toothed forceps, beneath which an oblique slit is to be 
made with scissors, so as to make a small, flap-like opening. 
Raise the flap, and pass in the bulbous point of a canule 
(glass, vulcanite or silver I, directed towards the centre of 
circulation. Tie this in the vein with the second ligature. 



164 



KEY NOTES OF MEDICAL tKAOXlOK. 



Have ready a glass funnel, to 
which is attached a foot of rubber- 
tubing, with the canule at the other 
end. Have the tube guarded by a 
clip. Pour the Solutio)i into the fun- 
nel ; open the clip, and let the Solu- 
tion start from mouth of the canule, 
when the clip must be shut, and the 
point immediately introduced into 
the vein. Now open the clip, raise 
the funnel and the patient's arm, 
and the Solution will be forced into 
the vein by hydrostatic pressure. 

Admit no air. A few small bub- 
bles of air do no harm — the quantity 
to cause death must be considerable. 
Inject no clots or foreign particles, 
which may act as emboli. Keep the 
Solution in a clean, warm, glass 
vessel. 

Inject slowly. Quantity — a half- 
V. pint to a pint. If signs of dyspnoea 

appear, stop the injection by lowering the funnel, and 
wait for it to subside. During process keep Solution warm 
by wrapping funnel with hot flannels. 

As soon as funnel nearly empty, withdraw canule from 
vein, apply compress and treat as simple wound. 




POISONING. 

EMETIC S. 

Aponiovpliia. Solution in water, 1 to 50; inject 5-10 
drops hypodermically. This is the most prompt and efficient 
emetic known. 

Ipecacuanha, powdered, 30 grains, in water. 

Sulphate-of-zinc, 30 grains in water; repeat if necessary. 
Prompt and safe. 

Sulphate-of-COpper, 5 to 10 grains dissolved in water. 

Mustard, a tablespoonful in a half-pint of warm water. 

Common salt, two tablespoonfuls in a half-pint of tepid 
water. 

A1VTIOOTKS. 

For Opium. Atropia sulph., gr. one-fortieth, or, Tr. 
Belladonna, 15 drops, repeated in 15 minutes if necessary. 
Strong coffee, ad libitum. 



L. 



POISONING— GENERAL DIRECTIONS. 



165 



For Arsenic. Dialyzed Iron, ounce doses frequently 
repeated. Hydrated Peroxide of Iron, give ad lib. Iron- 
rust. 

For Strychnine. Chloral, 30 grains, repeated if neces- 
sary; Bromide-of potassium, |ss. ; Animal Charcoal, ad lib.; 
Tannic acid, ad lib.; Chloroform; Ether; Nitrite of Amyl, 
by inhalation. 

For Acids. Lime-water, ad lib.; chalk-and-water; Mag- 
nesia, mixed in water; Ammonia and water, f j to fviij ; Ashes; 
Plaster from the wall; Tooth-powder, in water; Soap and 
water. 

For Alkalies. Vinegar, freely; Acetic acid and water; 
Lemon- juice; Muriatic acid, freely diluted with water; any 
dilute acid. 

For Narcotics. Coffee, strong, given freely; Nitrite of 
Amyl by inhalation; Ammonia; Galvanism; Stimulants. 

Multiple Antidote. 1$. Saturated Solution Sulphate 
of Iron, JUjss; Water ;xx; Calcined Magnesia, ;ij ; Animal 
Charcoal, 5j. 

Keep Iron solution separately, and the Magnesia and 
Charcoal mixed' in a bottle of water. When required for 
use. pour all into bottle together, and shake. Give ad lib., 
a wineglassful at a time. 

This is a perfect antidote to Arsenic, Zinc and Digitalis; 
it delays the action of Salts of Copper, Morphine and 
Strychnine, and slightly influences Salts of Mercury. 

Stimulants. Wine, Whisky. Brandy, Ammonia, Tea, 
Coffee, Ether. 

Instruments. Stomach-pump, Hypodermic syringe, 
soft-rubber catheter, enema-syringe. 

Demulcent Drinks. Milk; white of an egg and water- 
oil; linseed-tea; gruel; flour and water; boiled starch. 
Give in large quantities. 

GENERAL DIRECTIONS. 

Emetic. Give that emetic which can be most speedily 
obtained. If it be a corrosive poison, give copious draughts 
of demulcent drinks, followed by an emetic and the appro- 
priate antidote. If the emergency be great, and no emetic 
at hand, give copious draughts of tepid water, even though 
it be dirty or greasy ; then run the finger down the throat, 
to excite vomiting. The action of an emetic is facilitated 
if large quantities of fluid be swallowed. 



166 



KEY NOTES OF MEDICAL PRACTICE. 



Depression, if present, must be combated by stimulants, 
warm applications to the extremities, friction, galvanism, 
and, if the respirations fall below ten per minute, artificial 
respiration must be employed. Catheterize bladder in pro- 
longed cases. 

Battery. One pole at the side of the neck, the other 
over pit of stomach, or muscles of the chest. Or, touch the 
two poles to different attachments of the muscles of the 
chest, using strong current, sufficient to excite pain, and 
produce efforts at crying. 

Flagellation. In poisoning with narcotics, to combat 
the depression, and keep patient from sinking into fatal 
stupor, slap the skin with wet towels, spat the skin sharply, 
rub the soles of the feet with a stiff hair-brush; make every 
effort to rouse him. Walking the patient only adds ex- 
haustion to stupor — better lay him on a lounge and use 
flagellation. 

Douches. To aid in rousing when there is stujior and 
depression, dash cold and warm water, alternately, onto the 
head and chest. In apparently hopeless cases, two or three 
sharp blows on the chest, delivered in quick succession, 
will sometimes restore the heart's action. . 

Stimulation. Alcoholic stimulants may be used if the 
poison is not a narcotic. Coffee may be employed as a 
stimulant in Belladonna, Opium and other narcotic poison- 
ing; give an enema of a pint of hot, strong coffee. Am- 
monia may be given by inhalation, or by injection into 
veins. Strong tea is an excellent stimulant, and it also 
antidotes many poisons; give by the stomach, if possible. 
Whiffs of Ether, by inhalation, will stimulate the heart's 
action. 

Demulcents. In cases of poisoning by corrosive sub- 
stances, give, after the administration of the antidote and 
emetic, large quantities of mucilaginous drinks; preferably, 
white-of-egg and water. 

Stomach-pump. If it become necessary to wash out the 
stomach, and no pump is at hand, pass down the oesophagus 
and into the stomach, the end of a long rubber tube. 
Raise the free end above the patient's head, attach a small 
funnel to it, and pour down sufficient water to fill the 
stomach. Now carry the free end below the level of the 
stomach, and its contents will flow out, when, by repeating 
the process, fresh water may be syphoned back, and this 
process repeated indefinitely. 



POISONS. 



167 



KIM) OF POISOX. 



Unknown. 



Opium, 
Morphine, 
Laudanum, 
Chloral. 



Arsenic, 

Paris green, 
Seheele's green. 



Strychnine. / 
Picrotoxine. > 

Acids — 

Sulphuric, 

Nitric, 

Muriatic, 

Oxalic, 

Carbolic. 

Alkalies — 

Ammonia, 
Soda, 
Potash, 
Lye. 



Corrosive sublimate, 
Tartar emetic. 



Phosphorus. 



Nitrate-of-silver. ) 

(Lunar caustic.) ) 



TREATMKXT. 

| Provoke repeated vomiting; 
J Give demulcent drinks; 
Multiple antidote; 
Stimulate, if necessary. 

| Provoke repeated vomiting; 
| Give strong coffee, etc.; 
< Inject Belladonna; 
I Bouse by flagellation; 
[_ Artificial respiration. 

| Provoke ideated vomiting; 
| Give dialyzed iron, etc.; 
-{ Give dose castor-oil; 
| Secure rest; 
[_ Stimulate, 'if necessary. 

i Provoke vom iting once or twice ; 

J Give purgative; 

1 Give Chloral, etc.; 

{ Secure absolute quiet. 



Give an alkali; 
Provoke vomiting; 
Demulcent drinks; 
I Stimulate, if necessary. 



| Give an acid (vinegar) ; 
j Provoke vomiting; 
] Demulcent drinks; 
^ Stimulate, if necessary. 

f Provoke repeated vomiting; 

Give strong tea, freely; 

Give raw eggs and milk; 

Give dose castor-oil; 
[_ Stimulate, if necessary. 

Provoke vomiting; 

Sulphate of copper, sol. grs. iij, 

every 5 ms., till emesia; 
Epsom salts, 3SS.; 
No oils or fats. 

Strong solution salt and water, 

very freely; 
Provoke repeated vomiting. 



168 



KEY NOTES OF MEDICAL PRACTICE. 



Siigar-of-lead. 



Aconite. 



Digitalis. 



Belladonna. 

Stramonium, 

Hemlock. 

Toadstools. 

Tobacco. 



Chloroform. 
Carbon ic-acid-»a s. 



Alcohol. 



Decayed Meats / 
and Vegetables. ) 



Glass. 



Give Epsom salts repeatedly; 
Provoke repeated vomiting; 
Give demulcent drinks; 
^ Give dose castor -oil. 

f Provoke vomiting; 
| Stimulants, freely; 
~{ Digitalis tinct. gtt. xx, hypo- 
I derm.; mustard over heart; 
^ Artificial respiration. 

f Provoke vomiting; 
J Give strong tea ; 
Give stimxdants; 
Recumbent posture. 

Provoke vomiting; 
Stimulants, freely; 
Hot, strong coffee; 
Opium, tinct., gtt. iij — v, or 
] more; 

Cold to head, galvanism, flag- 
I ellation ; 
^ Artificial respiration. 

Abundance of fresh air; 
Pull tongue forward, clear 
mouth; 

I Loosen clothing, — head low; 
) J Alternate cold and tvarm 
) j douche; 

Inhalations Amyl Nitrite — Am- 
monia; 

Abtificial eespibation ! — Bat- 

\ tery. 

I Stomach-pump, or emetic; 
I Ammonia-and-water; 
■{ Battery and flagellations; 
| Cold douche to head; 
^ Artificial respiration. 

Provoke vomiting; 
Give purgative; 
Powdered charcoal, freely, 

If particles of glass have 
been swallowed, let the patient 
eat large quantities of bread- 
crumbs, to envelope it— then 
give emetic. Do not let it pass 
into the bowels. 



I 



INDEX. 



ABORTION, 9G 
Abscess 119 
Acne, 81 

Acupressure, 125 
After-pains, 104 
Agalactia, 108 
Ague, 19 

Ague, pernicious, 21 
Albumen-water, 146 
Alcohol-bath, 151 
Alcoholism, 69 
Alopecia, 81 
Amenorrhea, 112 
Anesthetics, 128 
Anal fissure, 132 
Angina pectoris, 40 
Antidotes, 164, 165 
Antiseptic surgery, 118 
Apoplexy, 6b 
Apomorphia, 164 
Artificial respiration, 162 
Asiatic cholera, 91 
Aspiration, 131 
Asphyxia of new-born, 102 

BANDAGES, 160 
Barber's itch, 81 
Barley-water, 146 
Bathing, 8 
Baths, 151 
Beef-tea, 147 
Bed, 8 

Biliary calculi, 59 

Bilious fever, 20 

Bilious temperament, 145 

Bladder, diseases of, 64 

Blepharitis, 83 

Brain, congestion of, 66 

Bran-bath,' 151 

Break-bone fever, 19 

Bright's disease, 61 

Bromidia, 161 

Bronchitis, 30 

Bubo, 138 

Bunion, 134 

Burns, 124 

CALCULI, biliary. 59 

" renal, 02 
Camphor, Rubini's, 169 
Cancrum oris, 41 
Cantharidal collodion, 149 
Carbuncles, 122 
Cautery, 125 
Catarrh, nasal, 24 
Cerebral meningitis, 67 



Cerebro-spinal fever, 11 
Cervix, lacerated, 105 
Chancre, 135 
Chancroid, 135, 137 
I Cholera, Asiatic, 91 
Cholera-infantum, 93 
Chorea, 75 
■ Chloasma, 81 
Chloroform, 128 

" test for, 150 
Circumcision. 133 
Climacteric, 115 
J Coccygodinia, 133 
Cold cap, 151 

" cloth, 150 

" douche, 152 

" drip, 150 

" pack. 8 
Collapse, temperature, 5 
Collections, 143 
Colic, 51 
Comedo, 81 
Condylomata, 137 
Congestion of liver, 56 
Congestion of lungs, 34 
Congestive chill, 21 
Constipation, 51 
Convalescence, 9 
Convulsions, 76 
Conjunctivitis, 83 
Cord, prolapsus of, 99 
Coryza, 24 
Corns, 134 
Cough, 28 

" whooping, 29 
Craniotomy, 102 
Croup. 27 
Cystitis, 64 
Cystocele, 99 

DEATH, signs of, 161 
Demulcents, 166 
Dengue, 19 
Diabetes mellitus, 94 
Diagnosis, 18 
Diarrhoea, 47 
Diet, infant, 145 
in fevers, 146 
" in typhoid, 8 
Diphtheria, 89 
Disinfectants, 152 
Dissection wound, 122 
Dropsy, 88 
Douche, 166 
Duration pregnancy, 98 
Dysentery, 49 



170 



INDEX. 



Dysmenorrhea, 112 

EAR, diseases of, 85 
Eclampsia, 103 
Ecthyma, 81 
Eczema, 81 
Egg-nog, 147 
Emetics, 164 
Endocarditis, 38 
Entozoa, 55 
Enuresis, 65 
Epididimytis, 141 
Epilepsy, 75 
Epistaxis, 25, 126 
Eruptive fevers, 18 
Erysipelas, 85 
Erythema, 81 

" nodosum, 81 
Ether, 128 
Eye, diseases of, 82 

FEBRIS ICTERODES, 23 
Fever, enteric, 5 

" intermittent, 10 

" jail, 9 

-* puerperal, 107 

" remittent, 20 

" ship, 9 

" scarlet, 13 

" typhoid, 5 

" typhus, 9 
Fevers, continued, 5 

" eruptive, 12 

" periodical, 19 
Fissure in ano, 130 
Fistula, rectal, 132 
Flagellation, 166 
Flexion, 126 
Fly blister, 149 
Fomentations, 150 
Fumigation, 153 

GANGLION, 133 
Gangrene, 121 
Gastralgia, 43 
Gastric catarrh, 42 

" fever, 12 

" ulcer, 44 
Glaucoma, 84 
Gleet, 140 
Good-will, 143 
Gonorrhoea, 138 
Gonorrheal ophthalmia, 83 
Granular lids, 84 
Gummata, 137 
Gum-water, 146 

HiEMATEMESIS, 45 

Htematuria, 65 

Haemoptysis, 35 . 

Haemorrhage, 125 

" post-partum, 100 
" rectal, 127 
" urethral, 126 
" uterine, 127 

Haemorrhoids, 54, 131 



Hare-lip, 129 
Hay-asthma, 26 
Headaches, 46, 47 
Headache, nervous, 72 

" congestive, 71 
Heartburn, 43 
Heart, diseases of, 38, 39 
Hemicrauia, 72 
Hives, 82 
Hepatitis, 57 
Hernia, 117 
Herniotomy, 117 
Herpes, 81 
Hordeolum, 82 
Hour-glass contraction, 102 
Hydrocele, 141 
Hydrophobia, 122 
Hydrocephalus, acute, 77 

" chronic, 78 

Hydrothorax, 37 
Hymen, imperforate, 99 
Hyperaemia of brain, 66 
Hypodermic medication, 159 
Hysteria, 75 

ICE-BAG, 150 
Iodoform, 160 

" powder, 161 
Imperforate hymen, 99 
Infant-diet, 145 
Influenza, 26 
Ingrowing nail, 134 
Intertrigo, 82 
Intussusception, 130 
Itch, barber's, 81 
Iritis, 84 

" syphilitic, 137 

JAUNDICE, 58 
Jail fever, 9 
Jurors, 143 

KERATITIS, 84 
Kidney, amyloid, 62 

" red granular. 61 
Kidneys, diseases of, 60. 62 
Keratitis, 84 

LACERATION of cervix, 105 

of perineum, 104 

Laryngitis, 27 

Laryngisums stridulus, 77 

Lead-colic, 52 

Legal medicine, 142 

Lente's solution, 22 

Leucorrhoea, 114 

Lichen, 82 

Ligature, 125 

Liver, congestion of, 56 

Lithaemia, 95 

Lithiasis, 95 

Listerism, 118 

Lung-fever, 33 

Lungs, congestion of, 34 

" oedema of, 34 
Lymphatic temperament, 144 



INDEX. 



171 



MALPRACTICE, 143 
Mania, 103 
Mastitis, 109 
Meas es, 14 
- Meningitis, cerebral, 67 

" cerebrospinal, 11 
Menorrhagia, 111 
Mercurial bath, 152 
Metrorrhagia, 110 
Milk diet, 148 
Milk-leg, 107 
Miscarriage, 97 
• Morbilli, 14 
Morphine-habit, 70 
Mutton-broth, 147 
Mustard bath, 151 
Mustard poultice, 149 
Myocarditis, 38 

NEVUS, 129 

Nervous temperament, 144 
Nephritis, 60-61 
Neuralgia, 72 
Nipples, sore, 110 
Nursing, 8 

OATMEAL WATER, 146 
' Obstetrics, 96 

(Edema glottidis, 25 

(Edema of lungs, 34 

Opium habit, 70 

Ophthalmia, 83 

catarrhal, 83 
gonorrhoeal, 83 
neonatorum, 83 
phlyctenular, 84 

Orchitis, 141 
Otalgia, 85 
Otorrhcea, 85 
Ovaritis, 114 
Ozrena, 25 

Ozama, syphilitic, 137 

PARACENTESIS ABDOMINIS, 
130 

Paraphimosis, 138 
Palpitation, cardiac, 39 
Parotitis, 41 
Parturition, 99 
Pemphigus, 82 
Pericarditis, 38 
Perineum, lacerated, 104 
Pernicious ague, 21 
Peritonitis, 50 
Pertussis, 29 
Phagedena, 138 
Phlegmasia dolens, 107 
Pin-worms, 56 
Pityriasis, 82 
Placenta prsevia, 100 

" retained, 102 
Pleuritis, 36 
Pleurodynia, 37 
Pneumonitis, 33 
Podalic version, 100 
Poisoning, 164-167 



I Poppy fomentation, 150 
Poultices, 149 

Post-parrum haemorrhage, 100 
Premature labor, 97 
Prolapse of cord, 99 
Pruritvis, 82 
Psoriasis, 82 

Puerperal eclampsia, 103 
Puerperal fever, 107 
mania, 103 

RECTAL ALIMENTATION, 147 
'• fistula, 132 
" haemorrhage, 127 
" stricture, 132 

Remittent fever, 20 
Renal calculi, 62 

Respiration, artificial, 162 

Retained placenta, 102 

Retention of urine, 133 

Rheumatism, 86 

Rigid os, 99 
" perineum, 99 

Rose cold, 26 

Rubeola, 14 

Rubini's camphor, 160 

Rupia, 137 

SALT BATH, 151 
Sanguine temperament, 144 
Sarcocele, 137 
Scalds, 124 
Scarlet fever, 13 
Schwartz, solution of, 163 
Sciatica, 73 
Shingles, 81 
Ship-fever. 9 
Shock, 127 
Sick-room, 7 
Sick-headache, 46 
Signs of death, 161 
Simple fever, 12 
Skin-diseases. 79-82 
Small-pox, 16 
Snake-bites, 122 
Solution of quinine, 22 
Spotted fever, 11 
Sprain, 122 
Starch poultice, 149 
Stimulation, 166 
Stings, 122 
Stomatitis, 41 
Stricture of rectum, 132 

" of urethra, 140 
Stye, 82 
Styptics, 126 
Sulphur-bath, 151 
Suppositories, nutrient, 148 
Surgery. 116 
Syphilis, 134 

" secondary, 136 

" tertiary, 136 

" treatment of, 135 

TAMPON, 111 
Tape-worm, 55 



172 



INDEX. 



Teeth, 158 
Temperaments, 144 
Temperature, 5, 159 
Tetanus, 74 
Thoracentesis, 130 
Tinea versicolor, 82 
Tonsilitis, 41 
Torsion, 125 
Tough membranes, 99 
Tracheotomy, 28 
Transfusion, 163 
Trepanning, 128 
Turpentine stupe, 150 
Twins, 102 

Typho-malarial fever, 20 
Typhus fever, 9 
Typhus, abdominal, 5 

ULCERS, 120 

" indolent, 120 
" irritable, 120 

Uraemia, G3 

Uric-acid diathesis, 95 

Urethral haemorrhage, 126 



Urinalysis, 154-156 
Urine, retention of, 133 
Urticaria, 82 
Uterine haemorrhage, 127 

VACCINATION, 17 
Vapor-bath, 152 
Variola, 16 
Varioloid, 16 
Venereal, the, 134 
Venesection, 127 
Version, 100 
Virus, 17 

Vital capacity, 157 

WATERBRASH, 43 
Wet pack, 152 
Weights and measures, 161 
White leg, 107 
Whooping.cough, 29 
Wine-whey, 146 
Wounds, treatment of, 118 

YELLOW FEVER, 23 



ERRATA. 

P. 25, for Ozcsiia, read Ozasna. 
P. 25, for gtts., read gtt. 

P. 52, 1. 11, for Dros., read Dios. 



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. 25 colored lithographs. $4.50. 

This work is intended as a text book for students, and a hand-book 
for the general practitioner. It is written in the clear and practical 
style so characteristic of the many other contributions to medical lit- 
erature by the author. 

The Homoeopathic treatment given has been clearly indicated, and 
only those remedies are considered which have borne the test in exten- 
sive hospital and private practice. 



Lectures on Fevers. By J. R. Kippax, M.D., LL.B., Pro- 
fessor of Principles and Practice of Medicine in the 
Chicago Homoeopathic Medical College; Clinical Lec- 
turer and Visiting Physician to the Cook County 
Hospital; Author of "Handbook of Skin Diseases," 
etc. Octavo. 460 pp. Illustrated. $4.50. 

This work consists of thirty lectures, embracing every form of Fever; 
its Definition, Histology, Etiology, Pathology and Homoeopathic Treat- 
ment, making a most important and valuable addition to our literature. 
Printed in large type and on good paper. 



The Science and Art of Obstetrics. By Sheldon. 
Leavitt, M.D., Professor of Obstetrics and Clinical 
Midwifery in Hahnemann Medical College and Hos- 
pital, Chicago; Author of "The Therapeutics of Ob- 
stetrics," etc. With an Introduction by Prof. Ludlam. 
659 pages, octavo. Price, cloth, $6.00; sheep, $7.00. 

We unhestatingly place this book at the head of its department, and 
have no doubt it will become the Text Book of all our colleges. — New 
York Medical Times. 



A Physiological Materia Bfediea. Containing all that is 
known of the Physiological Action of our Remedies, 
their Characteristic Indications, and their Pharma- 
cology. By W. H. Burt, M.D. 992 pages, octavo. 
Cloth* $7.00; sheep, $8.00. Third edition. 

We are sure that Dr. Burt's new work will have deservedly a rapid 
sale. Gross & Delhridge are a new publishing house in the medical 
line; but certainly they must be old hands in the business, for paper 
and printing leave nothing to be desired. May they never falter in 
such laudable work, and the eyes of the readers will bless them forever. 
— Dr. Lilienthul in North American Journal of Homozopathy. 



Clinical Companion to "The Physiological Materia 
Medica." Being a Compendium of Diseases, theiii 
Homoeopathic and Accessory Treatment, with valuable 
Tables and Practical Hints on Etiology, Pathology/ 
Hygiene, etc. By W. H. Burt, M.D. 252 pp. Illug^ 
trated'. Price, cloth, $2.50. Flexible leather, $3.00J 



A Complete Minor Surgery. The Physician's Vade- 
mecum. Including a Treatise on Venereal Diseases.' 
Just published. By E. C. Fkanklin, M.D., late Pror 
lessor of Surgery in the University of Michigan. 
Author of " Science and Art of Surgery," etc. Ulna*] 
trated with 2(50 wood cuts. 423 pp. Octavo. PrioeJ 
cloth, $4; sheep, $4.50. 



A Manual of Venereal Diseases. Being a condensed 
description of those affections and the Homoeopath™ 
Treatment. By E. C. Fkanklin, M.D., late Professorffl 
Surgery in the Homoeopathic Department of the UniJ 
varsity of Michigan; Surgeon to the University Homoe- 
opathic Hospital; Author of "Science and Art cl 
Surgery," " A Complete Minor Surgery," etc., etc. Ill 
pages. Octavo. 1883. Price, $1.25. 

The work is written clearly, the description of disease is ,l to the 
point," the diagnostic symptoms can not well be misunderstood, and' 
the indications for the use of the remedies considered are selected witB 
care and sound judgment. 



Practitioner's Guide in Urinalysis. By Clifford 
Mitchell, A.B., M.D., Professor of Chemistry anq] 
Toxicology, Chicago Homoeopathic College. AuthdM 
of " Manual of Urinary Analysis," " Clinical Signiflj 
cance of Urine," etc. 12 mo. Cloth. 205 pp. si. 50. 

No abler or more painstaking scholar than Dr. Mitchell adorns out' 
school of medicine, and his work shows forth these characteristics™ 
marked degree. It supplies a long-felt want, and no wide-awake physi- 
cian can do without it. 



Lectures on Clinical Medicine. By M. Le Dk. P. Joussm 

Physician to the Hospital Saint-Jacques, of Pa * 
Translated with Notes and Additions by R. Lu 
M.D., Professor of the Medical and Surgical Dis 
of Women and of Clinical Midwifery in the H 
mann Medical College and Hospital of Chicago. 
8vo of over 500 pages. Cloth, $4.50; half moro 
$5.00. 

The practitioner may here find cases analogous to puzzlers whicl 
cur in his own practice, and cannot fail to be benefited by their pen 



An Index of Comparative Therapeutics. With pro- 
nouncing Dose-List in the genitive case — a Homoe- 
opathic Dose-List — Tables of Differential Diagnosis, 
Weights and Measures — Memoranda concerning Clini- 
cal Thermometry, Incompatibility of Medicines, 
Ethics, Obstetrics, Poisons, Anaesthetics, Urinary Exam- 
inations, Homoeopathic Pharmacology and Nomencla- 
ture, etc., etc. By Samuel O. L. Pottek, A.M., M.D. 
Second edition. Cloth, $2.00; Leather Tuck, $2.50. 

The leading feature of this book is its comparative tabular arrange- 
ment of the therapeutics of the two great medical schools. Under 
each disease are placed in parallel columns the remedies recommended 
by the most eminent and liberal teachers of both branches of the pro- 
fession. By a simple arrangement of the type used, there are shown 
at a glance the remedies used by both schools, as well as the remedies 
peculiar to each, for any given morbid condition. Over .forty promi- 
nent teachers are referred to, besides occasional references to more 
than thirty others. In the first class are Bartholow, Ringer, Phillips, 
Piffard, Trousseau, and Waring of the old school; Hempel. Hughes, 
Hale, Buddock and Jousset among modern Homoeopathic authorities. 



The Physician's Condensed Account Book. An Epito- 
mized System of Book-Keeping, avoiding the necessity 
of separate Journal, Day-Book and Ledger, combining 
system, accuracy, and easy reference, with a minimum 
of labor. 272 pages. Price $3.50. 



The Physician's Day-Book and Ledger. Arranged by 
T. D. Williams. M.D. 220 pp. Price $2.00. Sample 
pages sent on application. 



Label Book, for the use of Physicians and Pharmacists. 

Containing more than thirty-live hundred gummed la- 
bels in laige clear type, and bound in a neat and sub- 
stantial manner. Price 50 cts. Sent postpaid on 
receipt of price. 



The Soul and the Body. A Sermon to Medical Students. 
By Kev. L. P. Mebcek. 12mo. Cloth. 31 pp. 25 cts. 

This discourse is simple, logical, scientific, eloquent. It elaborates 
and enforces the doctrine of the reality of the spiritual man, consider- 
ing the relation of the soul to the body as presented by old opinion, by 
science, ami by revelation. 



"Bless Thee, Bully Doctor!" By M. E. Dicus, M.D. 
Illustrated by 100 finely executed wood-cuts. Cloth. 
50 cts. 

This is certainly the most extraordinary book of the year. The 
Author has gathered and put into book form the cream of the medical 
wit of the world, and the whole thing is profusely illustrated. 



Key Notes of Medical Practice. By Chak. Gatohell, 
M.D., formerly Professor of The Theory and Practice' 
of Medicine, University of Michigan; Attending Phy- 
sician to Cook County Hospital. Pocket book. Flexi- 
ble leather. 172 pp. $2.00. 

This is a complete hand-book of Medicine, Surgery and Obstetrics, 
and is in such form as to actually go into the pocket, making it a verita- 
ble vade-mecum. 



Ruddock's Family Doctor. Being a reprint of Dr. Rud- 
dock's " Vade Mecum," " Diseases of Women," " Dis- 
eases of Infants and Children," and "Essentials of 
Diet." With Notes and Additional Chapters, by 
James E. Gross, M.D. 750 pp. Crown octavo. Cloth, 
$3.00. Ready March 1st, 1884. 



The American Homoeopathic Dispensatory. Designed 
as a Text Book for the Physician, Student and Drug- 
gist. By T. D. Williams, M.D., Member Illinois 
State Pharmaceutical Association, Active Member 
American Public Health Association, late Attending 
Gynaecologist Cook County Hospital, etc. About 700 
pp. Octavo. Ready April 1, 1884. 

The above work will be to the Homoeopathic school what the United 
States and National Dispensatories are to the Allopathic school— a 
desideratum. 



Clinical Papers on Ophthalmology and Otology. By 

J. H. Buffum, M.D., Professor of Ophthalmology and 
Otology in the Chicago Homoeopathic Medical College, 
and Author of " Diseases and Injuries of the Eye." 
22 pp. Octavo. 20 cts. 



The Medical Era. A Monthly Journal of Medicine. Each 
number contains 32 double-column quarto pages. 
Volume commences in July. Terms, $2.00 a year in 
advance. 



For Sale at all Homoeopathic Pharmacies or 
sent free by the Publishers on receipt of price 
A discount of 20 per cent, to physicians. 

CROSS & DELBRIDCE. 

48 Madison St., Ciiicago.